Evaluation of a hospice rapid response community service: a controlled evaluation

The study is a pragmatic quasi-experimental controlled trial. The primary outcome for the quantitative evaluation for patients is dying in their preferred place of death. Carers’ quality of life will be evaluated using postal questionnaires sent at patient intake to the hospice service and eight months later. Carers’ perceptions of care received and the patient’s death will be assessed in one to one interviews at 6 to 8？months post bereavement. Service utilisation costs including the rapid response intervention will be compared to those of usual care.The study will contribute to the development of the evidence base on outcomes for patients and carers and costs of hospice rapid response teams operating in the community.Trial registration: Current controlled trials ISRCTN32119670.While most people faced with a terminal illness would prefer to die at home [1,2], less than a third in England are enabled to do so with many dying in National Health Service (NHS) hospitals [2,3]. Given ideal circumstances, two thirds of terminally ill people would wish to die at home [2]. Many dying patients do not have effective choice over where they die. When professional support at home is available patients are more likely to die there [4,5]. The Department of Health policy guidance [6] stresses the importance of helping patients to achieve their wishes for place of death and the potential contribution of rapid response services to this cause.Patients with life limiting conditions are often admitted to hospital because of a crisis or challenge that could not be resolved at home [7]. The crisis often stems from uncontrolled symptoms, carer fear or stress, not having medication available, or not having enough information about the patient’s prognosis or disease trajectory [7]. Research has shown that patients who spend more time in hospital or hospice during their illness are more likely to die there [5], therefore keeping patients out of inpatient facilities may help improve the likeli