Palliative day care: what do services do?

Abstract

Palliative day care has expanded rapidly in the recent years, but the types of care available vary. To understand more about the different models of day care we conducted a questionnaire survey of the 43-day care centres in North and South Thames Regions in England (total population 13.75 million). The questionnaire covered: management, staffing and organizational policies; the numbers, types and reasons for referral; and the services and care provided. Forty (93%) centres responded. Centres had operated for between 1 and 16 years, mean 8 years. A total of 2268 day care places (mean per centre, 57) were available per week--with an estimated 1.77 places per 10,000 population. Twenty centres had never had a waiting list or had to prioritize patients; 30 had a discharge policy. The mean time the longest patient had been attending was 4.5 years, range 1-12 years. There were a total of 3627 new referrals per year or 3.06 per 10,000 population. Of the 2054 patients recorded by day care centres during a week of detailed monitoring, 1850 (90%) had cancer and 204 had other diseases--most commonly HIV or AIDS, motor neurone disease or stroke. Thirty-four centres were managed by nurses, two by social work or social service professionals, and the remainder by people with other backgrounds. Most units had doctors, nurses, chaplains, managers, aromatherapists and hairdressers, but occupational therapists, social workers, chiropodists, dietitians and music and art therapists were much more varied, as was whether these posts were paid. The most common activities were: review of patients' symptoms or needs, monitoring symptoms, bathing, wound care, physiotherapy, hairdressing and aromatherapy. Centres describing themselves as more or mostly social were less likely to undertake daily assessment of new symptoms and wound care (chi-squared 13.0, 10.1, respectively, df 4, P < 0.05). However, we found no significant differences between centres describing themselves as more medical or more social in reported levels of staffing, who was in charge, funding or most activities. The findings suggest that there are core activities offered in palliative day care, but also variations in medical assessments, nurse-led clinics, trips, art and music therapy, and artistic activities.

What is palliative day care?

“…There were eight studies from the UK [9,10,11,12,13,14,15,16,17] and four studies describing palliative day care services in the US [2,4,5,7]. The published literature highlights the differences in services provided at individual day centres.…”

“…The activities provided are similar at each centre: arts and crafts, personal care, baths, cooked meals, massage and relaxation [9,11]. Researchers have highlighted the variability in the aims and organisation of the different services [16,17] and suggested that variations in services depend upon the interests and motivations of those who run the centres rather than local need [13].…”

Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model

“…SPDC units provide support to patients and their carers and aim to increase continuity of care between inpatient and homecare settings [2], and help patients remain at home for as long as they wish [3]. In recent years there has been a notable increase in the number of units providing this service [4][5][6].…”

“…Although the multidisciplinary teamwork (MDT) approach is emphasised in all SPDC units, observational studies have found that different models of day care exists. [4,11] Traditionally, day care has been based on a social model, where the primary emphasis is on social interaction and carer respite rather than specific goal-orientated therapies. The aim is to provide an environment where patients have the opportunity to socialise with peers while participating in a range of recreational activities.…”

“…A questionnaire survey of 40 UK day care centres, for example, did not find many differences in staffing or activities types offerred between units describing their model as social or medical. [4] Quantitative studies evaluating patient outcomes in SPDC units are scarce in the literature. [12] Patient reported outcome measures (PROMS) have increasingly been used in palliative care, both in research and routinely in healthcare settings.…”