A scoping review of initiatives to reduce inappropriate or non-beneficial hospital admissions and bed days in people nearing the end of their life: much innovation, but limited supporting evidence.

BACKGROUND: Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. METHODS: Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. RESULTS: A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. CONCLUSIONS: A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent. TRIAL REGISTRATION: N/A.

Cancer in the London prison population, 1986-2005.

BACKGROUND: Little research has investigated cancer care in UK prisons. We wished to identify the number of new cases and the most common cancer diagnoses occurring each year in London prisoners, and the place of death for those who died from their disease. METHODS: Using the database of the Thames Cancer Registry, we identified cancer diagnoses in residents of seven London prisons from 1986 to 2005 and the place of death of patients dying from their disease between 1996 and 2005. RESULTS: On average, 31 patients were recorded as diagnosed with cancer while in prison within each 5-year period. In women, 83% (85/102) of diagnoses were in situ carcinoma of the cervix, and in men, 19% (11/57) were of lung cancer. None of the 25 patients recorded as dying from their disease died in prison. Most died in hospitals (48%, 12/25) or in hospices (28%, 7/25). CONCLUSIONS: London prisons contribute a small number of patients each year who require NHS cancer care, including those with advanced cancer who are released before death. Future studies should investigate cancer incidence for the national prison population, methods for improving screening coverage and follow-up, the timeliness of access to cancer treatments and end-of-life care, and prisoners' and health professionals' experiences of care.