Acceptability and perceived effectiveness of a district co‐ordinating service for terminal care: implications for quality assurance

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Abstract
As part of a randomized controlled trial of a new district co-ordinating service for the care of terminally ill cancer patients, the activities of the nurse co-ordinators and the acceptability and perceived effectiveness of the service were assessed Co-ordinators' activities were self-recorded, professional caregivers completed a postal questionnaire, and family carers were interviewed at home Thirty-eight per cent of patients allocated to the co-ordmators were not visited at home Overall, 41% of professionals had heard of the co-ordinating service and 20% had been contacted A third of relatives, whether allocated or not to the co-ordinating service, felt that terminal care of their patient was not well co-ordinated and that they did not know how to get the help they needed for their dying relative It may be that the nurse co-ordinators were unwilling or unable to relinquish their skills in order to provide a‘broker’style of co-ordination Perhaps less skilled co-ordinators would have been more successful Moreover, the co-ordinating service had no budgetary responsibility Those concerned with quality assurance in co-ordination of terminal care might consider the skill mix and professional training of the co-ordinators as well as their budgetary responsibilities and authority