While most people faced with a terminal illness would prefer to die at home [1
], less than a third in England are enabled to do so with many dying in National Health Service (NHS) hospitals [2
]. 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
]. 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 likelihood that patients will be able to die at home. Rapid response teams providing palliative care respond quickly to crises and emergencies to help patients avoid admission to hospice or hospital. They integrate with routine community care and withdraw after the crisis has resolved, which may be death. They provide intense care for a few days at a time and operate on a 24/7 on-call basis. They are available at a time when the patient and/or carer are most vulnerable and when no other service is available or able to manage the crisis.
The effectiveness of rapid response teams has not been rigorously evaluated and there have been only three studies from the UK [8
] which were descriptive evaluations, lacking control groups and two had small sample sizes (17 patients and 62 patients). The studies all identified above national average (21%) number of patients dying at home [3
], 42%, 41% and 29%, and below national average use of institutional care. Thus rapid response services appear to prevent crisis admissions and increase the number of patients able to die at home, though these evaluations lack the power to provide an adequate evidence base without a control group.
It is important to evaluate new palliative care services in terms of patients’ preferences and service delivery costs, but it is also important to consider the impact of care in terms of carers’ quality of life and experiences. The Department of Health in the End of Life Care Strategy
] discusses the concept of a good death and identifies key elements of the dying persons' experience, including dignity and respect, effective pain management, familiar surroundings and presence of family and friends. However it is not clear what factors are key to carers’ experiences.
The aim of the study is to contribute to the development of the evidence base on the consequences and costs of hospice rapid response teams, compared to usual care. It will also contribute to an understanding of the ways in which carers’ perceive and evaluate a ‘good death’.