Specification of palliative care day services: a three-centre study

Background: Palliative care day services (PCDS) are provided routinely across the United Kingdom. Due largely to the historically localised nature of development, wide variability in and ambiguity concerning the organisation and content of services persists. This variability militates against strategic planning and development.Aims: We aimed to address this knowledge deficit by identifying core service provision within the UK by mapping three regional PDCS providers using the Donabedian quality framework.Methods: A retrospective, observational study design involved two components. Firstly, a review of local policy and operational documents at each site provided information on the structure of PCDS (how care is organised). This covered four key areas: service organisational structure; funding arrangements and expenditure; staffing and management structure, and; other information relevant to estimating the costs of PCDS. Secondly, a retrospective review of the clinical records of patients referred to the service at each site delivered information on the process of PCDS (what is provided). Using reported attendance figures, cases were randomly selected according to a proportionate regime.Results: The review covers key features of: the local-level patient populations, including socio-economic and diagnostic profile; referral, allocation and discharge; all interventions offered; service uptake, and; contextual information on patient circumstances, need and preferences for care. It delivers a comprehensive body of evidence concerning the structure and process of PCDS.Conclusions: Our study makes a fundamental contribution to a previously limited evidence base on the organisation, content and mechanisms of delivery of PCDS in the UK