Helping people to die in their place of choice is a major focus of the national End of Life Care Strategy. The palliative care charity Marie Curie Cancer Care aims to realise this ambition by working with local stakeholders such as hospices, social services and the NHS through their 'Delivering Choice' Programme. A Delivering Choice project was set up and delivered in two counties in southwest England. This consisted of end of life care coordination centres, end of life care facilitators, a discharge in-reach nursing service, 24 hour advice line, an integrated personal support team, an end of life care electronic register and various documentation. The Centre for Academic Primary Care was asked to evaluate this holistic service re-configuration using routine data (e.g. death, hospital, service usage) and realistic evaluation. We found that family carers appreciated the end of life services and reported high levels of care coordination, as did professionals. Those using Delivering Choice were at least 30% less likely to die in hospital or have an emergency hospital admission or A&E visit in the last 30 or 7 days of life than those who did not use DCP after adjusting for confounding variables such as condition, age, gender and deprivation. DCP patients had higher Charlson scores than non DCP patients. All services contributed to the reduction in secondary care useage. However, the care coordination centres appeared to be the most effective component of the packages offered. The indicative costs saved were £440,000 across the two counties. For further information please see the
final project report (PDF, 4,583kB) and/or the
executive summary report. (PDF, 325kB)
