title: Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders.
abstract: understanding how best to provide palliative care for frail older people with non-malignant conditions is an international priority. We aimed to develop a community-based episodic model of short-term integrated palliative and supportive care (SIPS) based on the views of service users and other key stakeholders in the United Kingdom.
  
  
  
  transparent expert consultations with health professionals, voluntary sector and carer representatives including a consensus survey; and focus groups with older people and carers were used to generate recommendations for the SIPS model. Discussions focused on three key components of the model: potential benefit of SIPS, timing of delivery and processes of integrated working between specialist palliative care and generalist practitioners. Content and descriptive analysis was employed and findings were integrated across the data sources.
  
  
  
  we conducted two expert consultations (n = 63), a consensus survey (n = 42) and three focus groups (n = 17). Potential benefits of SIPS included holistic assessment, opportunity for end of life discussion, symptom management and carer reassurance. Older people and carers advocated early access to SIPS, while other stakeholders proposed delivery based on complex symptom burden. A priority for integrated working was the assignment of a key worker to co-ordinate care, but the assignment criteria remain uncertain.
  
  
  
  key stakeholders agree that a model of SIPS for frail older people with non-malignant conditions has potential benefits within community settings, but differ in opinion on the optimal timing and indications for this service. Our findings highlight the importance of consulting all key stakeholders in model development prior to feasibility evaluation.
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors: Anna E
authors: AE
authors: Bone
authors: Institute of Pharmaceutical Science, King's College London,  London, UK.
authors: Myfanwy
authors: M
authors: Morgan
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors: Matthew
authors: M
authors: Maddocks
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors: Katherine E
authors: KE
authors: Sleeman
authors: Department of Geriatric Medicine, Brighton and Sussex Medical School, Brighton, UK.
authors: Juliet
authors: J
authors: Wright
authors: Northbourne Medical Centre, Shoreham-by-Sea, West Sussex, UK.
authors: Shamim
authors: S
authors: Taherzadeh
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors: Clare
authors: C
authors: Ellis-Smith
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.
authors: Irene J
authors: IJ
authors: Higginson
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.|Sussex Community NHS Trust, Brighton and Hove, UK.
authors: Catherine J
authors: CJ
authors: Evans
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003153:Community Health Services / Q000458:organization & administration*; D032921:Consensus; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004739:England; D017144:Focus Groups; D016330:Frail Elderly / Q000523:psychology*; D000073496:Frailty / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D000073597:Stakeholder Participation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: consensus; frail older people; palliative care; primary health care; qualitative research