Understanding integrated care pathways in palliative care - context, approaches, outcomes

Background Policy and evidence based guidelines have aided in identifying a greater need for advanced palliative care services. However, there is still evidence of individuals dying undignified deaths with little pain control, therefore inflicting unnecessary suffering. In West Northumberland use of new commissioning powers have enabled an innovative Integrated Care Pathway (IPC) to be created in order to improve arrangements for individuals with life limiting illnesses who require palliative care. The ICP itself is novel as it aims to begin palliative care in the last 6 months of life, therefore intervening early to ensure a good death. What is not known is if this ICP works, how it works and who it works for. Design A realistic evaluation will identify context, mechanism and outcome (CMO) configurations within the ICP and facilitate exploration of how the ICP works and who it works for. Mixed methods and small sample sizes will be used in each section of research to capture the breadth of the ICP. Phase 1 will identify if the ICP works through analysis of NHS MIQUEST data, the Death Audit and the Quality of Death and Dying Questionnaire. Phase 2 employs soft systems methodology with data from focus groups with health professionals to identify how the ICP works. Phase 3 involves use of the Miller Behavioural Style Scale for analysis on communication in palliative care, and interviews with palliative care patients and bereaved relatives. Discussion This study will benefit West Northumberland by providing objective data on the palliative care ICP which will aid in developing and improving the ICP via feedback as the research occurs. The research will benefit any national implementation as it will highlight the contexts crucial for successful implementation, the mechanisms that facilitate implementation and the outcomes that can potentially be achieved by this novel approach.