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.
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.
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.
The study has five stages:
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.