ABSTRACT
BACKGROUND: The national Cancer Reform Strategy recommends delivering care closer to home whenever possible. Cancer drug treatment has traditionally been administered to patients in specialist hospital-based facilities. Technological developments mean that nowadays, most treatment can be delivered in the out-patient setting. Increasing demand, care quality improvements and patient choice have stimulated interest in delivering some treatment to patients in the community, however, formal evaluation of delivering cancer treatment in different community settings is lacking. This randomised trial compares delivery of cancer treatment in the hospital with delivery in two different community settings: the patient's home and general practice (GP) surgeries. METHODS/DESIGN: Patients due to receive a minimum 12 week course of standard intravenous cancer treatment at two hospitals in the Anglia Cancer Network are randomised on a 1:1:1 basis to receive treatment in the hospital day unit (control arm), or their own home, or their choice of one of three neighbouring GP surgeries. Overall patient care, treatment prescribing and clinical review is undertaken according to standard local practice. All treatment is dispensed by the local hospital pharmacy and treatment is delivered by the hospital chemotherapy nurses. At four time points during the 12 week study period, information is collected from patients, nursing staff, primary and secondary care teams to address the primary end point, patient-perceived benefits (using the emotional function domain of the EORTC QLQC30 patient questionnaire), as well as secondary end points: patient satisfaction, safety and health economics. DISCUSSION: The Outreach trial is the first randomised controlled trial conducted which compares delivery of out-patient based intravenous cancer treatment in two different community settings with standard hospital based treatment. Results of this study may better inform all key stakeholders regarding potential costs and benefits of transferring clinical services from hospital to the community. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN66219681.
Subject(s)
Antineoplastic Agents/therapeutic use , Day Care, Medical , Delivery of Health Care/organization & administration , Family Practice , Home Care Services , Neoplasms/drug therapy , Adult , Aged , Community Health Centers , Female , Humans , Injections, Intravenous , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Quality of Life , Young AdultABSTRACT
BACKGROUND: Informal carers provide the bulk of palliative home care. They largely rely on general practitioners (GPs) and district nurses to support them in this role, yet little is known about what carers themselves consider important in this support. AIM: To identify what informal carers valued in the palliative support provided by GPs and district nurses by using carers' own descriptions of such support. DESIGN OF STUDY: Retrospective interviews. SETTING: Primary care in Cambridgeshire. METHOD: Semi-structured interviews with bereaved carers of 48 patients with cancer and 12 patients with non-cancer diagnoses. Content analysis of carers' evaluative descriptions of GP and district nurse support. RESULTS: The accessibility of the GP and district nurse emerged as the most important aspect of support. Enlistment of help from other agencies was also extensively mentioned, together with provision of equipment. Attitude or approach during interactions, and relationship with the professional were important, particularly regarding GP support, whereas support for the carer, information, and symptom control were mentioned less often. Data suggested that support was not as good for older patients (> or =75 years), but this finding requires further investigation. CONCLUSION: Results largely confirmed findings of previous, quantitative research and the importance of a patient-centred approach. What emerged most strongly, however, was the central importance of accessibility of support services for lay carers responsible for end-of-life home care. This mainly concerned GP and district nurse support, but accessibility of additional care and equipment were also important. In short, carers' main focus was the basic support that enabled them to sustain care in the home.
Subject(s)
Caregivers/psychology , Home Nursing/psychology , Neoplasms/nursing , Palliative Care/psychology , Terminal Care/methods , Aged , Attitude of Health Personnel , Bereavement , Data Collection , Family Practice/standards , Female , Humans , Male , Middle Aged , Palliative Care/methods , Physician-Patient Relations , Retrospective Studies , Terminal Care/psychologyABSTRACT
The aim of this project was to investigate how patients view the care and support provided by their doctors and nurses. Forty-three patients with a life expectancy of 1 year or less who were being looked after in their own homes were asked to give their views of the support given by general practitioners, district nurses and Macmillan nurses. Patients had predominantly positive views of the support received. The content of their positive statements suggested that psychosocial aspects of support, including communication and kindness and consideration shown, were valued most. Actions in the form of helpfulness, organization of support and being accessible were also important, while clinical aspects received less emphasis. Clinical aspects of care were emphasized more when patients expressed negative views of support. Patients' statements suggested that emotional support and information were provided predominantly by Macmillan nurses.
