ACCEPTABILITY AND PERCEIVED EFFECTIVENESS OF A DISTRICT COORDINATING SERVICE FOR TERMINAL CARE - IMPLICATIONS FOR QUALITY ASSURANCE

As part of a randomized controlled trial of a new district co-ordinati ng service for the care of terminally ill cancer patients, the activit ies of the nurse co-ordinators and the acceptability and perceived eff ectiveness of the service were assessed. Co-ordinators' activities wer e self-recorded; professional caregivers completed a postal questionna ire; and family carers were interviewed at home. Thirty-eight per cent of patients allocated to the co-ordinators were not visited at home. Overall, 41% of professionals had heard of the co-ordinating service a nd 20% had been contacted. A third of relatives, whether allocated or not to the co-ordinating service, felt that terminal care of their pat ient was not well co-ordinated and that they did not know how to get t he 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 skill ed co-ordinators would have been more successful. Moreover, the co-ord inating 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 t heir budgetary responsibilities and authority.