Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study

Abstract

Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121-£190 (excluding volunteer contribution) to £172-£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2:-£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis.

What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

“…For instance, in one hospice, day therapies were part of the overall community nursing service, whereas in others day therapies was a separate service. The interventions offered within day therapies also varied as has been described elsewhere [8].…”

“…Hospices are evolving and have shifted their focus from caring for patients with cancer to the development of services for all terminally ill patients; while also seeking to offer services earlier in the illness trajectory when needed. As hospice services have developed to suit the needs of their local population and receive only partial statutory funding through local commissioning processes, there is much variability in the services offered [7][8][9].…”

A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic?

“…A recent study of costs in three palliative day care services in the UK (2020) found that the contributions of volunteers (as complementary therapists, drivers, catering staff or hairdressing) was equivalent to roughly a third (28-38%) of running costs per day per patient. [ 58 ] The hospice sector depends upon volunteers, and thus community engagement that increases the visibility of hospice volunteering could be considered essential to workforce planning.…”

An analysis of the construct validity and responsiveness of the ICECAP-SCM capability wellbeing measure in a palliative care hospice setting

“…Data were collated from two studies conducted within the same setting, one a before-and-after cohort study examining the costs and outcomes of the use of palliative care day services (PCDS) [15] and the other exploring the use of an educational intervention for staff designed to improve the management of constipation in hospice patients [16,17]. Both recruited from a national chain of hospices in the UK.…”

“…As this was the first use of the ICECAP-SCM, there were no available data to perform a sample size calculation. In addition, the research question on the validity of the ICECAP-SCM in hospice care was not the main focus of the studies where this data was collected, with sample size being driven by their primary research questions [15][16][17].…”