King's College Hospital

Summary of Research Study

Why does this research matter?

Many people as they age live with several ongoing conditions, such as heart failure and dementia.  This means the care and treatment can be more complicated for older people and they may take longer to recover after illness or be nearing the end of life. Community hospitals are important in the care for older people. They provide services to support recovery to enable people to live as well as possible and anticipate and plan for nearness to end of life. Importantly, they enable people to remain close to home.

What are we trying to do?

We focus on the management of clinical uncertainty. Clinical uncertainty often happens at points of decline in wellbeing. This means we are unsure if a person will recover or continue to decline. Clinical uncertainty is a complex area of clinical practice. We want to enhance how we manage clinical uncertainty to improve communication and holistic care for older people admitted to a community hospital, and those close to them. We focus on older people where there is uncertainty as to their recovery or continued decline leading eventually to the end of life. We believe that this represents the area of greatest need. This also responds to national priorities for research on improving access to palliative care for all, training for staff to deliver, and person-centred care to tailor care and treatment to the person's priorities.

We want to find ways to improve assessment to understand 'what matters to the person' on admission to a community hospital, how we communicate with the patient and family about what to expect, review if we are meeting patient goals, and how we ensure care continues as planned on discharge. There are tools for clinical practice that support assessment, communication and continuity of care. These tools are standardized documents that support care process such as holistic assessment. But they have been developed mainly in acute hospitals. This limits our understanding on how well they would work in a community hospital.

What will we do?

We want to develop and evaluate the feasibility of using a set of tools - called SPACE – Symptom and Psychosocial Assessment and Communication Evaluation. The tools intend to improve communication and holistic care in community hospitals and during clinical uncertainty for patients and those close to them.

Design and methods

The study has five stages:

  • reviewing work already published, to ensure that we are incorporating the best evidence-based tools in SPACE  and how to implement in clinical practice to sustain use and improve outcomes of care
  • analysing anonymous national data on people admitted to a community hospital in England and following up over a year after their admissions to understand what usually happens to them. This will help us understand for example, when, and where people died and priorities to improve communication on patient discharge.
  • interviews with patients and caregivers and clinical staff in community hospitals to test out and improve the tools we are using in SPACE, how to implement the tools in clinical practice, and explore what are the main benefits for patients and families.
  • testing the feasibility of using the tools in community hospitals from admission to discharge to explore the potential benefit for patients and families, processes for using in practice, acceptability for patients and clinical staff and patient participation in the study.
  • bringing all these findings together to give a clear understanding on the tools used in SPACE, the best ways to introduce and implement them in clinical practice and how to evaluate their use for the future.

The study will take place over 5 years. A group of lay members interested in improving access to palliative care for older people work with us. The study will be an important step forward in transforming the care in community hospitals by providing staff with evidence-based tools to enhance care processes and improve outcomes. The findings intend to increase our understanding of care for people in community hospitals and during clinical uncertainty and provide a solid foundation for a future study to test how the tools we develop may work nationally.