Does a social model of hospice day care affect advanced cancer patients' use of other health and social services? A prospective quasi-experimental trial.
BACKGROUND
Hospice day care (HDC) services have developed but no trials evaluate their impact on the other health and social care services.


OBJECTIVE
The purpose of this study was to evaluate the effect of HDC on the use of health and social services in a prospective quasi-experimental study.


METHODS
The trial compared consecutive patients receiving HDC, with two control groups: a 'before' group and a 'standard care' group. All data was collected in face to face interviews at baseline and then at 6-8 weeks and 12-15 weeks. The health and social service use at baseline and follow-up interviews were examined by five categories (community, hospice, social care support, hospital, and therapist). The multivariate analysis of covariance (MANCOVA) was used to test service use differences between groups, adjusting for potential confounders.


RESULTS
In total, 37, 50, and 76 patients were recruited to the day care, standard care and before groups. Patients in the HDC group used significantly more social care support (11.5 +/- 18.9 versus 3.2 +/- 10.0, P = 0.015) and therapists (0.9 +/- 1.7 versus 0.2 +/- 0.4, P = 0.009) than the standard care at the baseline. The therapist service use from the baseline to the first follow-up reduced (mean change +/- SD, -0.3 +/- 0.6; 95%CI, -0.7 to 0.0) in the HDC group and increased in the standard care group (mean change +/- SD, 0.1 +/- 0.5; 95%CI, -0.1 to 0.3), the difference was significant (P = 0.003). No other changes in service use were significant in other study periods.


CONCLUSIONS
HDC appears to supplement existing services with little effect on the other community and hospital services.
Higginson
Irene J
IJ
School of Medicine at Guy's, King's College and St Thomas' Hospitals, Department of Palliative Care, Policy and Rehabilitation, King's College London, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK. irene.higginson@kcl.ac.uk
Gao
Wei
W
Amesbury
Brendan
B
Normand
Charles
C
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003631:Day Care, Medical; D004739:England; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D017051:Hospice Care; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009369:Neoplasms; D011446:Prospective Studies; D012947:Social Work / Q000706:statistics & numerical data*; D006113:United Kingdom