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Designing a population-based approach to integrated end of life care on a small island


Giovanna I Cruz ,

Hospice Isle of Man, GB
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Sarah M McGhee,

Hospice Isle of Man, GB
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Anne Mills

Hospice Isle of Man, GB
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The Isle of Man is a small island of 83,000 residents situated in the Irish Sea. The Island is a self-governing Crown Dependency of the United Kingdom. Due to its geographic isolation, the Island provides a unique opportunity to re-design and co-create a model of care that incorporates private, public, third sector and community elements. Financially strained health services recognise that sustainability depends on integration across sectors in the community. Hospice Isle of Man, the only specialist provider of end of life care on the Island, is working with the Department of Health and Social Care and the Council of Voluntary Organisations to develop the Isle of Man’s Integrated Palliative and End of Life Care Strategy. The World Health Organization and the Worldwide Palliative Care Alliance have underscored the need for palliative care to be based on individual needs rather than on disease-specific diagnoses or prognosis Connor and Sepulveda, 2014. In order to provide the right care, at the right time, in the right place, the Island-wide strategy requires a population-based approach and methods to match patients and services based on needs. Early stakeholder engagement facilitated through a workshop held on December 7th, 2017 with members of the health services including primary care, mental health, social health, third sector and carers identified the need for earlier identification of patients at the end of life in order to provide the most appropriate services. It was recognised that patient networks and resources must be taken into account in order for gaps to be adequately identified and to meet patient needs. Patient journey case studies with different diagnoses identified needs across the spectrum of care – including the third sector and patient networks. Age-based segmentation fails to recognize the contribution and potential capacity of those who would otherwise be considered “dependent” in traditional demographic analyses. Cross-sector integration of care raises additional questions and challenges. Who leads the process? What does person-centred care look like with cross-sector involvement? Who can function as a “key worker”? How will fragmented services organise? How do charitable organisations balance mission and goals with the requirements of an integrated network? What trade-offs are stakeholders willing to make? By combining findings obtained through focus groups, patient and carer journeys and cross-sector workshops we identify the non-medical determinants of need for community end of life support and propose strategies to meet them. These findings will form the basis for initiatives that will be piloted and evaluated prior to Island-wide implementation. 

How to Cite: Cruz GI, McGhee SM, Mills A. Designing a population-based approach to integrated end of life care on a small island. International Journal of Integrated Care. 2018;18(s2):327. DOI:
Published on 23 Oct 2018.


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