Identifying the science and technology dimensions of emerging public policy issues through horizon scanning.

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.

Improving end-of-life care in nursing homes: implementation and evaluation of an intervention to sustain quality of care.

BACKGROUND: Internationally, policy calls for care homes to provide reliably good end-of-life care. We undertook a 20-month project to sustain palliative care improvements achieved by a previous intervention. AIM: To sustain a high standard of palliative care in seven UK nursing care homes using a lower level of support than employed during the original project and to evaluate the effectiveness of this intervention. DESIGN: Two palliative care nurse specialists each spent one day per week providing support and training to seven care homes in Scotland, United Kingdom; after death audit data were collected each month and analysed. RESULTS: During the sustainability project, 132 residents died. In comparison with the initial intervention, there were increases in (a) the proportion of deceased residents with an anticipatory care plan in place (b) the proportion of those with Do Not Attempt Cardiopulmonary Resuscitation documentation in place and (c) the proportion of those who were on the Liverpool Care Pathway when they died. Furthermore, there was a reduction in inappropriate hospital deaths of frail and elderly residents with dementia. However, overall hospital deaths increased. CONCLUSIONS: A lower level of nursing support managed to sustain and build on the initial outcomes. However, despite increased adoption of key end-of-life care tools, hospital deaths were higher during the sustainability project. While good support from palliative care nurse specialists and GPs can help ensure that key processes remain in place, stable management and key champions are vital to ensure that a palliative care approach becomes embedded within the culture of the care home.

An assessment of methods used to evaluate the adequacy of cancer pain management.

This paper assesses different methods of evaluating pain management. We used the established methods of pain prevalence measurement and the Pain Management Index (PMI) to compare pain management between two groups who might be expected to have different outcomes. We also developed and used a method to assess how quickly pain was controlled for each group (time to pain control). We compared a group of cancer patients (n=712) managed by general practitioners in the community (Community Group) and a group of patients (n=152) treated in a Specialist Palliative Care Unit (Hospice Group) using all methods. The time to pain control method identified a significant difference between the two groups (P<0.01 log rank test), with the Hospice Group achieving pain control significantly faster. By contrast, neither the pain prevalence method nor the PMI could detect any difference (P=0.11 Wilcoxon test). The established methods of pain prevalence measurement and PMI are limited by their inability to measure pain over time and to assess prescribers' response to changing pain. Dynamic methods that evaluate changes in prescribing and pain levels over time must be developed in order to accurately assess pain management.