Award Title: Exploration of 24/7 lone working practices, support, and education needs of Marie Curie Healthcare Assistants (HCAs) providing palliative care in the community across the UK.
Funder: Marie Curie

Abstract: Rapid changes in response to covid-19 has had a profound and ongoing effect. Whilst coronavirus has brought more attention to how patients’ lives are ending, little is known about the experience and support for lone workers who provide the care. Prior to covid-19, the demand for palliative care was projected to rise by 42% by 2040. The pandemic however has led to a surge in demand for palliative care, yet there exists a stark lack of evidence from those who provide the 24/7 frontline care, especially from the unregistered Health Care Assistant (HCA) perspective. 

HCAs are the largest group of staff in Marie Curie delivering direct care in the community. Recruitment to those roles nationally is ongoing and retention of staff is low – in 2019 only 55% of new HCA recruits were still in post after 12 months. To date, no studies have focused on the HCAs lone working practice across the 24/7 period, resulting in little understanding of their needs to provide such care, or how healthcare providers can support them in their role. 

To gain greater insight into this subject a qualitative exploratory design will be adopted. A series of one-to-one interviews will be undertaken with HCAs employed in MC community palliative care teams for a maximum of 12 months. Interviews will be guided by a semi-structured interview guide, formulated by a review of the literature and experts in the field of palliative care. The findings will provide an understanding of MC HCA workforce role and experiences in the delivery of lone working to palliative care patients and caregivers in a pandemic and will highlight the educational and support needs of the workforce across the 24/7 period. The project will make policy and practice recommendations for supporting the HCAs in community–based palliative care.

Lay Abstract: Lone working is defined as ‘those who work by themselves without close or direct supervision’. There can be benefits to lone working, such as the rewards of being able to provide one-to-one, personal care and support for people. However, providing palliative care in the community can be challenging and stressful for lone workers, especially when providing symptom management and emotional support to patients and families without the support of a co-worker. As a result, staff turnover, especially for HCAs can be high which is difficult for the organisation managing care in the community and for patients and families when staff keep changing.

The Covid-19 pandemic has had profound effect on patients’ lives, as well as healthcare staff. Prior to the pandemic we knew that demand for palliative care was projected to rise, but the pandemic has led to a rapid increase in demand for palliative care in the community. Little is known, so far, about experiences and the needs of the frontline HCAs who work alone 24/7 delivering palliative care in the community. 

For that reason, it is important and beneficial to understand the challenges and rewards that newly appointed HCA lone workers experience when caring for patients with palliative and end of life needs in the community. This can then help identify what their support and learning needs are to help them remain in their role and provide the best palliative and end-of-life care to patients and families in the community. To gain this knowledge and understanding the researcher will interview a group of HCAs employed in Marie Curie community palliative care teams. The project will make policy and practice recommendations for supporting HCAs in community–based palliative care

Research Activity Codes: 7.2 END OF LIFE CARE;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: GENERIC HEALTH RELEVANCE