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A realist evaluation of a "single point of contact" end-of-life care service.

PURPOSE
Following the development of a service that consisted of a "single point of contact" to coordinate end-of-life care (EoLC), including EoLC facilitators and an urgent response team, we aimed to explore whether the provision of coordinated EoLC would support patients being cared or dying in their preferred place and avoid unwanted hospital admissions.


DESIGN/METHODOLOGY/APPROACH
Using a realist evaluation approach, the authors examined "what worked for whom, how, in what circumstances and why". Multiple data were collected, including activity/performance indicators, observations of management meetings, documents, satisfaction survey and 30 interviews with service providers and users.


FINDINGS
Advance care planning (ACP) increased through the first three years of the service (from 45% to 83%) and on average 74% of patients achieved preferred place of death. More than 70% of patients avoided an emergency or unplanned hospital admission in their last month of life. The mechanisms and context identified as driving forces of the service included: 7/7 single point of contact; coordinating services across providers; recruiting and developing the workforce; understanding and clarifying new roles; and managing expectations.


RESEARCH LIMITATIONS/IMPLICATIONS
This was a service evaluation and the outcomes are related to the specific context and mechanisms. However, findings can be transferable to similar settings.


PRACTICAL IMPLICATIONS
"Single point of contact" services that offer coordinated EoLC can contribute in supporting people to be cared and die in their preferred place.


ORIGINALITY/VALUE
This paper provides an evaluation of a novel approach to EoLC and creates a set of hypotheses that could be further tested in similar services in the future.