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Title: Improving the experiences of palliative care for older people, their carers and staff in the Emergency Department using experience-based co-design
Author: Blackwell, Rebecca
ISNI:       0000 0004 5369 1511
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2015
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Background: The Emergency Department (ED) is often viewed as an inappropriate environment for terminally ill older patients; however, palliative admissions to the ED continue to occur. Despite an increased focus on end of life and palliative care services, the role of the ED has generally been neglected in the UK. Aim and Methodology: This study used the participatory action research methodology, Experience-based Co-design to identify concerns and solutions to improve experiences of palliative care provision in the ED for older patients (65+), their carers and staff at Guy’s and St Thomas’ Hospital NHS Foundation Trust ED. Methods: Experiential narrative data were gathered using audio and filmed interviews, and analysed using a thematic framework to identify the main challenges. Findings were validated by the staff and patient/carer groups, who selected four improvements priorities (IP) each (eight in total). Findings, in the format of a patient/carer film and a staff presentation were shared at a co-design event which enabled participants to collaboratively select shared IPs and began to redesign applicable elements of the service. The study was enhanced by findings from a data collection field trip to a geriatric-only ED at Mount Sinai Hospital in New York. Using interviews and observation additional background contextual data on palliative care coding and ED impact on the patient journey were identified. Findings: The four staff IPs were: ‘helping them [patients and carers] find their way’, ‘being informed and informing them [patients and carers]’, ‘seeing the person in the patient’, and ‘expectations of the care we can give’. Patient and carer IPs were similar: ‘finding our way’, ‘knowing what’s happening’, ‘seeing the person in the patient’, and ‘expectations of care’. The co-design event explored these issues and the group began to develop plans to improve them. Immediate strategies aimed to: improve self-management and ownership, develop ED-based palliative care pathways and staff training, create dedicated palliative care space in the ED, improve IT and databases, improve patient experience, and share the learning of the study. Impact: Early study impact includes palliative care referral improvements, introducing routine ED visits by the palliative care team, development on palliative care pathway processes in the ED, development of mandatory palliative care training in the ED which includes the patient/carer film. Based on feedback from the co-design event, the film was expanded to include the staff experience as well.
Supervisor: Grocott, Patricia Rosalind; Lowton, Karen; Robert, Glenn Brian Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available