Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway

Palliat Med. 2016 Jul;30(7):690-7. doi: 10.1177/0269216315626352. Epub 2016 Jan 27.


Background: The need for palliative care is growing internationally with an increasing prevalence of non-malignant diseases. The integrated care pathway was implemented in primary care by multidisciplinary teams from 2009 in a locality in the North East of England. Fourteen general practitioner practices provided data for the study.

Aim: To find whether, how, and under what circumstances palliative care registrations are made for patients with non-malignant diseases in primary care.

Design: General practitioner practice data were analysed statistically and qualitative data were collected from health care professionals and members of relevant organisations.

Findings: A mixed-effects logistic model indicated a significant difference beyond the 0.1% level (p < 0.001) in registrations between the malignant and non-malignant groups in 2011, with an odds ratio of 0.09 (=exp(-2.4266)), indicating that patients in the non-malignant group are around 11 times (1/0.09) less likely to be registered than patients in the malignant group. However, patients with non-malignant diseases were significantly more likely to be registered in 2012 than in 2011 with an odds ratio of 1.46, significant beyond the 1% level. Qualitative analyses indicate that health care professionals find registering patients with non-malignant diseases stressful, yet feel that their confidence in treating this population is increasing.

Conclusion: The integrated care pathway began to enable the reduction in inequalities in care by identifying, registering and managing an increasing number of palliative patients with non-malignant diseases. Consensual and inclusive definitions of palliative care were developed in order to legitimise the registration of such patients.

Keywords: Palliative care; cancer; malignant; non-cancer; non-malignant; realist evaluation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care, Integrated / organization & administration*
  • England
  • Healthcare Disparities / organization & administration
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Logistic Models
  • Neoplasms / psychology
  • Neoplasms / therapy*
  • Odds Ratio
  • Palliative Care / organization & administration*
  • Palliative Care / psychology
  • Palliative Care / statistics & numerical data*
  • Primary Health Care / organization & administration*
  • Primary Health Care / statistics & numerical data*
  • Socioeconomic Factors