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7 Realist evaluation of a coordinated end-of-life care service
  1. Nikolaos Efstathiou,
  2. Anna Lock,
  3. Suha Ahmed,
  4. Linda Parkes,
  5. Susan Law and
  6. Tammy Davies
  1. University of Birmingham, Sandwell and West Birmingham Hospitals NHS Trust


Background Dying at home or in a hospice are the most preferred options among the population in England. However, the lack of co-ordinated End-of-Life (EoL) services means that most patients will not die in their preferred place of death. Following the development of a new service that consisted of a single point of contact (hub) to coordinate care, EoL facilitators and rapid response teams, we developed an hypothesis that the provision of co-ordinated EoL services would increase supporting patients being cared or dying in their preferred place. Evaluating this new service would be challenging using traditional research methods.

Methods This mixed-method study used a realist evaluation approach to examine ‘what works for whom, how, in what circumstances and why’. Multiple data were reviewed, including activity/performance indicators, observations of management meetings, documents and 29 individual interviews with the service providers and users. Framework analysis was used to synthesise the findings.

Results During the first year of operation 1000 patients were registered on the service register. 99% of callers had a service contact within one working day of urgent referral and transfers to hospice care if required were organised quickly. Advanced Care Planning progressively increased through the year and 70% of patients received their preferred choice of care and 64% were able to achieve preferred place of death. The mechanisms identified as driving forces of the service included: one point of access; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations.

Conclusions The use of realist evaluation allowed us to understand how specific preconditions made some outcomes more likely to occur. The identified mechanisms appear to have improved coordination of EoL services, communication between service providers, and service user’s experiences; this was made possible through challenging conceptions about pre-existing services and traditional roles.

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