Unscheduled care attendance by people with advanced cancer is significantly greater than previously estimated

A new paper studies the use of any NHS unscheduled care for people with advanced cancer, where previous papers have only focused on A&E. Initial funding for this research was provided by PATCH.

The study finds that the majority of unscheduled care given to people who die from cancer is GPOOH (GP Out-of Hours). Common causes for visits are pain and palliative care. Previous studies based on only A&E (accident and emergency) visits have led to an underestimation of the frequency of unscheduled care use.

One significant finding is that frequent users made up a small proportion of the cohort, but accounted for more than half of the visits.

This concentration of unscheduled care use at the end of life and among a small number of users implies that any unscheduled care use should trigger in-hours care review and anticipatory care planning[1].

The study is based on a dataset of 2443 people who died from cancer in Tayside, Scotland, during 2012-2015.

PATCH provided initial funding to Sarah Mills for data extraction and storage.

I am delighted to share with the PATCH community the publication of my research into use of unscheduled care by people who die from cancer. This work was only possible through having received a PATCH Scotland grant, which enabled me to pay for the creation of the computer programme that enabled the extraction of general practice out-of-hours clinical information. This enabled the creation of the first general practice out-of-hours dataset, which is still the most detailed of its kind. This work is the first overview of all unscheduled care (GP out-of-hours and A&E combined). Because of the funding I received from PATCH I was able to successfully apply for and obtain a PhD Fellowship through the Chief Scientist’s Office, which will enable me to take this work further while pursuing a higher degree. I am forever indebted to PATCH for supporting me at such a pivotal point in my career and hope that my future work is a credit to them and to the PATCH funders and community.

Dr Sarah Mills

At PATCH, we extend our deepest gratitude to Sarah and her fellow researchers. Their thorough research grants us all a better understanding of the situation, and gives a solid foundation for their suggestions of anticipatory care planning, improved community support, and streamlined care pathways. As the paper indicates, these methods can help ensure unscheduled care attendances only happen when appropriate and unavoidable.

References and footnotes

  1. Sarah Mills, Deans Buchanan, Bruce Guthrie, Peter Donnan and Blair Smith (2019) "Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland", British Journal of General Practice, 69 (689): e860-e868 (Accessed online 09/12/2019).