The impact of poor coordination of community service provision on end of life care for patients with cancer

Background: Providing service users with a say in their care is integral to UK government health policies. For patients dying of cancer there is an emphasis on giving choice regarding their preferred location for care, which includes the option of dying at home. Initiatives such as the End of Life Care Programme that promote patients choices including their preferred place of death the have been established However despite these policies the situation persists where patients are being admitted to hospital in the terminal phase of their illness when they have expressed a desire to die at home. Aim: The study aimed to investigate the views of community nurses involved in end of life care for people with cancer in an attempt to explore the factors that influence where they are cared for and ultimately die. Methodology: A qualitative study, using audio taperecorded focus group interviews was employed for the study. A purposive sample of 19 district nurses and community specialist palliative care nurses from across two primary care trusts in the North West of England participated in two focus groups. Data were analysed for emerging themes using thematic analysis. Results and discussion: The findings of this study suggest that poorly coordinated service provision impacts upon enabling patients with cancer, who wish to die at home to achieve this goal. Poor discharge planning from the hospital, including a lack of communication with the community nursing team, coupled with delays in commencing additional care services and the delivery of equipment are all identified as influencing factors. This paper discusses these findings and recommendations for improving the services offered to terminally ill cancer patients and their families will be given.