Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Abstract

Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

Family caregivers’ support needs during allo-HSCT—a longitudinal study

“…Therefore, a limitation might be that the answers reflect the FC spontaneous understandings of the questions, without any possible conversations with clinical staff. However, the CSNAT has been used earlier as a survey in validation studies [ 18 , 19 ] and to evaluate a care model [ 47 ].…”

‘My wife is my doctor at home’: A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting

“…Providing home-based palliative care and managing symptoms at home continues to be an issue in palliative care, even in developed countries where formal support exists. 1,2 Specialist palliative care in home settings may be beneficial to patients and caregivers across different settings and in many countries. 3 Even with professional support, home-based care can result in substantial emotional, social, and physical demands on informal caregivers.…”

A enfermagem no cuidado paliativo domiciliar de idosos apoiada por avaliações multidimensionais: revisão integrativa

“…Ressalta-se preocupação com a qualidade de vida e atenção baseada no estabelecimento de confiança com paciente e cuidador; reconhecimento da angústia, capacidade e disposição do cuidador para o cuidado considerando-se a idade, conhecimentos, estado emocional, confiança, disponibilidade e experiência. Além disso, inclui o acompanhamento do luto familiar após o óbito do idoso (Abernethy et al, 2013;Allen et al, 2012;Burns & McIlfatrick, 2015;Duursma, Schers, Vissers, & Hasselaar, 2011;Esteban-Burgos et al, 2019;Harman et al, 2019;Henoch, Strang, Löfdahl, & Ekberg-Jansson, 2019;Johnston et al, 2018;Lamppu et al, 2019;Mitchell et al, 2016;Roberts, McLeod, Stajduhar, Webber, & Milne, 2014;Rotter & Grant, 2018;Stajduhar et al, 2011).…”

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