Evaluation Of Community Palliative Care Settings: a discussion of the issues

Introduction: As health services have increased in complexity, evaluation has become an integral part of policy, program development and service provision. Palliative care services have also experienced increased demand for evaluation. This paper explores the experiences and challenges in undertaking independent evaluations of community palliative care services. Methods: The authors draw on their experiences in two different studies involving the evaluation of after-hours palliative care services. Data collection included the use of questionnaires and semi-structured interviews to explore the experience of after-hours service provision from the perspective of clients, visiting nurses, GPs, after-hours triage nurses and service managers. Findings: The paper highlights issues about processes and systems of the evaluation itself, rather than the quality of the palliative care provided. Key issues were: project design; achieving an ethical evaluation process; working with vulnerable populations; staff/manager perceptions of evaluation processes; and factors pertinent to funding bodies. Discussion: These findings are discussed in the light of current literature and strategies for more effective evaluation processes which are appropriate for a very vulnerable population; as well as considering the needs of staff in remote and often staff-poor services, and managers who have responsibilities for healthcare services in which palliative care provision is but a small part. Conclusion: Suggested strategies to facilitate future evaluation processes include: careful attention to research design and dissemination of outcomes; the utilisation of processes which lead to ownership of problems and solutions by those most involved in the service provision; greater uptake by ethics committees of standardised forms and processes; recognition that vulnerable populations have the right to make their own informed decisions about involvement; and increasing vision in both services and funding bodies about the most appropriate application of research outcomes for best service provision.