Assessing structure, process and outcome in palliative day care: a pilot study for a multicentre trial

Palliative day care is an expanding service which remains under-researched. Study designs need to be developed to evaluate the costs and outcomes of t he service in ways which are meaningful to patients, clinicians and policy- makers. At the same time, these must be open to the same criteria for rigou r and reliability as techniques used elsewhere in health and social service evaluation. To this end, a developmental stage of exploratory research was undertaken at the start of a major multicentre trial of palliative day car e to meet two clear aims: to understand more about the structure and proces ses of palliative day care, and to identify ways in which service outcomes could be evaluated and measured. In-depth observations at five palliative d ay care centres were undertaken across one health region. This provided a b etter understanding of the models, outcomes and processes of palliative day care in five different environments. Centres represented the spectrum of m edical and social care models and findings were analysed using an organisat ional systems approach. The findings showed that, despite the lack of a nat ional strategic approach to developing the service, the centres all provide d a core set of services which were broadly similar. However, differences i n philosophy, ownership, and organisation affected how the services were pr ovided and may have an impact on the costs of the service. The study has pr ovided a more in-depth understanding of palliative day care services in ord er to design an effective research strategy for evaluating a service which crosses the boundaries of health and social care.