Delivery Models and Health Economics of Supportive Care Services in England: A Multicentre Analysis.

AIMS: Improvements in cancer treatment have led to more people living with and beyond cancer. These patients have symptom and support needs unmet by current services. The development of enhanced supportive care (ESC) services may meet the longitudinal care needs of these patients, including at the end of life. This study aimed to determine the impact and health economic benefits of ESC for patients living with treatable but not curable cancer. MATERIALS AND METHODS: A prospective observational evaluation was undertaken over 12 months across eight cancer centres in England. ESC service design and costs were recorded. Data relating to patients' symptom burden were collected using the Integrated Palliative Care Outcome Scale (IPOS). For patients in the last year of life, secondary care use was compared against an NHS England published benchmark. RESULTS: In total, 4594 patients were seen by ESC services, of whom 1061 died during follow-up. Mean IPOS scores improved across all tumour groups. In total, £1,676,044 was spent delivering ESC across the eight centres. Reductions in secondary care usage for the 1061 patients who died saved a total of £8,490,581. CONCLUSIONS: People living with cancer suffer with complex and unmet needs. ESC services appear to be effective at supporting these vulnerable people and significantly reduce the costs of their care.

Use of high-fidelity simulation to improve communication skills regarding death and dying: a qualitative study.

OBJECTIVES: The objectives of this study were to explore medical students' experiences of communicating with patients and their carers about death and dying, and to assess whether using high-fidelity simulation improved students' confidence in discussing cardiopulmonary resuscitation. METHODS: This qualitative study was carried out at a hospital in the south of England. Participants were 7 final-year medical students. Tutorials were developed using high-fidelity simulation to teach communication skills regarding discussion of cardiopulmonary resuscitation with patients and carers. Scenarios involved a simulated ward environment, a high-fidelity simulation mannequin and actor playing the role of a carer. Data were collected through joint interviews carried out by one researcher which were audio recorded and transcribed verbatim. The same researcher analysed the data using framework analysis. RESULTS: Students reported a lack of experience observing conversations with patients and carers about death and dying. They also reported a lack of opportunities to interact with dying patients during their training. Barriers reported by students included healthcare professionals' and patients' attitudes. Students reported a lack of confidence and preparedness to have consultations with patients and carers about death, dying and cardiopulmonary resuscitation as junior doctors. They perceived role-play scenarios observed by their peers to be stressful, and this detracted from the learning experience. Students reported that the high-fidelity simulation scenarios were more realistic than low-fidelity ('role-play') scenarios. This improved the learning gained from the sessions and improved confidence among some students. CONCLUSIONS: This study has suggested that high-fidelity simulation may be a useful adjunct for undergraduate communication skills training in palliative medicine. Further research is required to assess whether improvements in confidence described by students in this study translate to discernible improvements in competence, and whether using high-fidelity simulation in this setting is cost-effective.