Title: Wellbeing of lone working Healthcare Assistants (HCAs) delivering palliative care in the community and its impact on staff retention.
Funder: Marie Curie

Abstract: Background: HCAs have a pivotal role caring for patients dying at home and supporting their family caregivers. Their role as unregistered practitioners is complex and includes responsibility for the assessment of complex symptoms and being proactive in preventing, managing and escalating concerns. The complexity of this role, combined with variable experience and role preparation, was reported to have an impact on the wellbeing of the lone worker. Aim: Provide evidence to inform the development of interventions to enhance support, wellbeing strategies and retention of community-based HCA lone workers providing palliative care. Design: Mixed-method sequential explanatory online design. Data Collection: Phase 1: An online survey of Marie Curie community lone worker HCAs across the UK first to scope the psychological wellbeing among this group and to assess and compare the psychological wellbeing and intention to leave among lone working HCAs in relation to their employment and demographic characteristics (e.g., gender, age, marital status, education level, care experience etc.). Phase 2: Online interviews with Marie Curie community lone worker HCAs to collect in-depth qualitative data around the same issues. Data Analysis: Quantitative data will be transferred to SPSS, cleaned and subject to analysis using descriptive and inferential statistics. Free text answers will be analysed using thematic analysis. Interview data will be transcribed verbatim and analysed using thematic analysis. Implications: This research will provide a national profile of the level of wellbeing of lone working HCAs and inform Marie Curie of the current situation in relation to intention to leave and the possible causes. Researchers hope it will help to uncover approaches and actions that may be useful and effective in the context of retaining community lone workers and provide evidence for developing interventions and enhancing appropriate support and wellbeing strategies.

Lay abstract: Healthcare assistants have an important role across all healthcare systems, including care of patients dying at home and support of their family caregivers. Majority of Marie Curie community based healthcare assistants are lone workers visiting patients in their own homes. They provide symptom management and emotional support to patients and families as part of their role, but they do so often without the appropriate supervision of registered professionals, limited support of colleagues and inadequate role preparation. This can be challenging and stressful for lone workers. As a result, staff turnover is high, which is difficult for the organisation managing care in the community and may impact the capacity of services to deliver care to patients and families. Additionally, ongoing recruitment causes financial burden for the organisation. For that reason, it is important to understand the level of self-reported wellbeing of lone workers and the intention to leave the job. To gain this knowledge and understanding we plan to: 1. Send an online survey to all Marie Curie lone working healthcare assistants to ask about their wellbeing, job satisfaction, stress levels and intention to leave 2. Invite a smaller group of Marie Curie lone working healthcare assistants to participate in interviews to talk more in depth about their wellbeing, stress levels and what would increase their intention to stay in their position? Once we have analysed this information, we will develop recommendations to influence the wellbeing strategy and people strategy within Marie Curie, ensuring that healthcare assistants’ experiences and needs are heard and this group is supported.

Research activity codes: 7.2 END OF LIFE CARE;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE