Sustainability of a Nurse-Led End of Life (PEACH) Community Model of Care.
Josephine Sau Fan Chow, Nutan Maurya, Kim Jobburn and 1 others
PMID 40845307WHAT IT FOUND
Most people receiving a nurse-led home palliative package, alongside usual GP, community nurse and specialist palliative care services, died at home: 436 of 598 and 395 of 482 in two service periods.
Carers reported high satisfaction, especially pain relief.
Key findings
01Most clients in the PEACH package died at home: 436 of 598 in the first period and 395 of 482 in the second; 77% and 84% of clients who preferred home met that preference.
02Clients who preferred hospital or a palliative care unit at referral were more likely to be admitted there than clients who preferred home.
03Carers reported high satisfaction: 123 of 199 surveys were returned in the first period, 13 of 17 care aspects were rated acceptable or exceptional, and 86% of the 21 carers who responded in the second were satisfied or very satisfied.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational service evaluation, not a randomised trial, so it cannot show that the PEACH package caused more people to die at home. The package was given alongside usual GP, community nurse and specialist palliative care services, so the contribution of any single part cannot be separated. The carer survey had a low response rate, especially in the second period, and carers were invited after the client died, so respondents may not represent all families. Patients were selected because they were near the end of life, had very limited function, and had a caregiver living with them, so results may not apply to patients without those supports. The two provider periods differed in referral patterns, diagnoses, and local service arrangements, so comparisons across periods are descriptive.
Declared interests
The PEACH program was funded by the NSW government, and the authors declared no conflicts of interest.
The easy way to misread this
Do not read the high home-death rates as proof that the nurse-led package alone works. Patients also received usual GP, community nurse and specialist palliative care services, and this observational study had no comparison group.