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Approaches to community-based palliative care provision by children's hospices in the UK
1Martin House Children's Hospice, Wetherby, West Yorkshire, England.
Insights
Children
Area of Science:
- Pediatrics
- Palliative Care
- Community Health Nursing
Background:
- Increasing prevalence of life-limiting conditions in UK children.
- Growing demand for home-based palliative care services.
- Children's hospices are key providers of pediatric palliative care.
Purpose of the Study:
- To investigate UK children's hospice approaches to home-based palliative care.
- To identify community team composition and patient numbers.
- To understand management of planned and unplanned care needs.
Main Methods:
- Internet-based questionnaire survey distributed to UK children's hospices.
- Data collected on team size, workforce, services, and out-of-hours care.
- Survey targeted 10 key areas of hospice community care.
Main Results:
- 14 hospices responded, supporting 1,618 children (825 at home).
- Registered nurses formed the largest staff group across all teams.
- Home care included planned short breaks and responsive palliative nursing (advance care planning, symptom control).
- Out-of-hours care primarily offered via telephone support.
Conclusions:
- Community palliative care models are evolving.
- Specialist and advanced practice nurses enable complex home care.
- Home-based care is expanding for children with life-limiting conditions.
Abstract:
The number of children in the UK with life-limiting conditions and the demand for home-based palliative care is increasing. Children's hospices remain a dominant provider of palliative care. This study aimed to determine the approaches taken by children's hospices across the UK in meeting the planned and unplanned health needs of children and their families who receive palliative care at home. In addition, the survey aimed to identify the professional composition of community teams and the number of children and families supported by each service. An internet-based questionnaire survey was sent to all children's hospices in the UK, comprising ten questions exploring the size of the team, geographical areas covered, workforce composition, services offered and approaches to managing unplanned, out of hours care. Responses were received from 14 (26%) of the hospices. A total of 1,618 children and their families were being cared for by these hospices, of whom 825 received care at home. Registered nurses constituted the greatest proportion of staff and were employed by all teams. Care provided at home was broadly split into two categories: planned short breaks and responsive palliative nursing. The latter comprised advance care planning, anticipatory prescribing and active symptom control. Out of hours care was usually offered in the form of telephone support. Models of community-based care are evolving to include nurses practising at specialist and advanced levels, allowing more children with increasingly complex conditions to be cared for at home.