Walshe, Catherine Elizabeth and Dodd, Steven Robert and Hill, Matthew and Ockenden, Nick and Payne, Sheila Alison and Preston, Nancy Jean and Perez Algorta, Guillermo Daniel (2016) How effective are volunteers at supporting people in their last year of life? : a pragmatic randomised wait-list trial in palliative care (ELSA). BMC Medicine, 14: 203. ISSN 1741-7015
Full text not available from this repository.Abstract
Background: Clinical care alone at the end of life is unlikely to meet all needs. Volunteers are a key resource, acceptable to patients, but there is no evidence on care outcomes. This study aimed to determine whether support from a social action volunteer service is better than usual care at improving quality of life for adults in the last year of life. Methods: A pragmatic, multi-centre wait-list controlled trial, with participants randomly allocated to either receive the volunteer support intervention immediately or after a four week wait. Trained volunteers provided tailored face to face support including befriending, practical support and signposting to services, primarily provided within the home, typically for 2-3 hours per week. The primary outcome was rate of change of quality of life at 4 weeks (WHO QOL Bref, a general, culturally sensitive measure). Secondary outcomes included rate of change of quality of life at 8 weeks and Loneliness (De Jong Gierveld Loneliness Scale), social support (mMOS-SS) and reported use of health and social care services at 4 and 8 weeks. Results: 196 adults (61% (n=109) female), mean age 72. No significant difference found in main or secondary outcomes at 4 weeks. Rate of change of quality of life showed trends in favour of the intervention: physical quality of life domain (b= 3.98 (CI -0.38 to 8.34), psychological domain (2.59 [CI -2.24 to 7.43], environmental domain (b= 39 [-4.13 to 4.91]). Adjusted analyses to control for hours of volunteer input found significantly less decrease in physical quality of life in the intervention group (slope (b) 4.43 (CI 0.10 to 8.76). While the intervention also favoured the rate of change of emotional (b=-.08 [CI -.52 to .35] and social loneliness (b=-.20 [CI -.58 to .18]), social support (b=.13 [CI-.13 to .39], and reported use of health and social care professionals (b = .16 [CI -.22 to .55]), these were not statistically significant. No adverse events reported. Conclusions: Clinicians can confidently refer to volunteer services at the end of life. Future research should focus on 'dose' to maximise likely impact. ISRCTN 12929812 20.5.2015