A mixed method study to describe the factors associated with palliative care inequalities experienced by heart failure patients in the North West, and the impact of these inequalities

Background

Early palliative care consistently leads to better patient and caregiver outcomes. These include improvement in symptoms and quality of life, and reduced caregiver burden and healthcare costs (Smith et al., 2012). Alongside symptom control, supporting patients to die in their preferred place of care is a particular focus as most patients who express a preference prefer to die at home and avoid hospital-based care towards the end-of-life. At present, only 45% of people die at home (Royal College of Physicians, 2021), and therefore, we need to better support patients to achieve their choice. Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer (Gadoud et al., 2014).

Socioeconomic and other factors are known to have an impact on accessing palliative care services and place of care and death, but these have been predominantly investigated from a secondary care perspective, such as access to specialist palliative care services or using data from hospital records (Hasson et al., 2020, Chen et al., 2015, Davies et al., 2021, Bloomer and Walshe, 2021). Little is known about the factors impacting access to palliative care in primary care settings.

Aim 

To explore factors associated with inequity in recognising a palliative care approach in the community and association with place of death and care for people with heart failure and how these can be overcome.   

Methods 

Mixed method study with three concurrent phases with findings integrated and presented to deliberate panels of key stakeholders. A mixed method approach will enable the phenomenon of interest (factors associated with inequalities) to be explored using qualitative and quantitative methods. These have similar weighting within the study, although there is scope (and expertise within the supervision team) for the PhD student to flexibly develop the project in response to emerging outcomes or personal interest.

Phase 1 is a systematic literature review to identify factors associated with inequalities in clinicians identifying a need for palliative care in community heart failure patients.

Phase 2 is a cross sectional analysis of contemporaneously collected GP and linked hospital records of heart failure decedents (2018-2020) in the Morecambe Bay area to determine the impact on outcomes associated with health inequalities (Gadoud et al., 2014, Gadoud et al., 2020).

Phase 3 uses in-depth interviews with General Practitioners (GPs) in the North West to explore perceived factors associated with inequalities in recognising a palliative care approach is needed.

Phase 4 utilises the results from phases 1-3 to identify and develop recommendations about how the factors associated with inequalities for people with heart failure can be overcome (Brearley et al., 2014).

Potential impact

A national priority setting exercise for palliative care research has identified non-cancer palliative care and community palliative care as key priorities (James Lind Alliance, 2015, Taylor et al., 2020). The integration of deliberative panels ensures findings reaches stakeholders involved in policy, practice and research. Reducing admissions and time in hospital are key policy drivers. Ensuring high quality end of life care and choice is a high priority for clinical practice. Relevance of the study is expected beyond palliative care- for example understanding other sorts of health inequalities. 

Application details

Applications should be made directly to Dr Amy Gadoud [Email Address Removed] and should include:

CV (max 2 A4 sides), including details of two academic references

A cover letter outlining your qualifications and interest in the studentship (max 2 A4 sides)