What models of community palliative rehabilitation exist for adults in the United Kingdom? – a national cross-sectional survey

Background

Palliative care for advanced illness is expected to increase globally by 87% by 2060. Palliative rehabilitation helps patients manage symptoms and maintain independence. It is increasingly delivered in community settings where practitioners visit patients at home, or in outpatient clinics. However, there is limited current evidence on how community palliative rehabilitation is delivered in the UK.

Aim

To describe current models of community palliative rehabilitation provision.

Methods

A cross-sectional online survey aimed at senior clinicians or managers of adult hospices that outreach into the community and generalist community palliative rehabilitation services in the United Kingdom in 2024.

Results

Of the 381 NHS community rehabilitation and specialist palliative care organisations surveyed, 96 (25%) responded, with most being independently funded hospices or nationally funded hospital trusts (NHS Trusts). Partial responses were included. All organisations employed physiotherapists and most (96%, 74/77) employed occupational therapists in their community palliative rehabilitation teams but over half did not employ any other AHPs (60%, 46/77). Independent hospices were more likely to employ specialist palliative care physiotherapists (71% vs. 21%) and occupational therapists (54% vs. 30%) than NHS community organisations and treat patients with cancer and COPD (100% vs. 68% respectively for cancer, 100% vs. 59% respectively for COPD). Most clinicians (89%), irrespective of organisation type, asked for further education or guidance to treat patients with palliative diagnoses. Many organisations could not always provide information in languages other than English (86% 57/66) or interpretation services at appointments (51%, 34/66). Integration of community rehabilitation services was better with specialist palliative care services (50%, 30/60) and primary care (42%, 26/60), but weaker with secondary care (21%, 13/60) and third sector organizations (11%, 7/60).

Conclusions

There is variation in community palliative rehabilitation models across the United Kingdom in terms of staffing composition, casemix, equity of access for patients, and integration with other services. Further education or guidance is needed for clinicians in rehabilitation teams supporting patients with palliative diagnoses.