P-161 Equity of access to inpatient hospice care in the United Kingdom
Bibliographic record
Abstract
Background Hospice inpatient care is often considered gold standard, yet only supports a minority (Department of Health. End of life care strategy: promoting high quality care for all adults at the end of life. 2008). For example, in 2019, 84.7% of deaths in hospices in England and Wales were from cancer, while 15.3% were non-cancer (Tobin, Rogers, Winterburn, et al. BMJ Support Palliat Care. 2022;12(2):142–51). There is a lack of research into this, not least due to a ‘paucity of evidence around the factors that influence access to palliative care’ (Antonacci, Barrie, Baxter, et al. J Aging Res. 2020;2020:3921245). Aim To better understand access to UK inpatient hospice care, focussing on the reported barriers to admission. To understand who might be marginalised from care, what is considered a good death, and potential suggestions for overcoming health inequity. Methods A mixed method approach combining online survey, and interviews. Participants were recruited from three groups: providers of hospice inpatient care, referrers into that care, and the public. Surveys were analysed using univariate statistics, while interviews were interrogated reflexively, using thematic analysis. Results 132 people completed the survey. 63% of providers, 46% of the public, and 89% of referrers said access to hospice inpatient care is not equitable within the UK. 32 people were interviewed. 86% of providers, 83% of the public, and 100% of referrers believed that access is not equitable. Barriers include lack of knowledge, geography and infrastructure, referral and admission processes, recruitment and retention of clinical staff, and finance. Suggestions to overcome barriers include education, public relations, and improving statutory commissioning. The findings from the small survey also suggest who is, and is not, likely to be admitted to inpatient hospice care in the UK. Conclusion This research will help towards an understanding of who is unable to access care, why, and what can be done to overcome this. Recommendations based on these findings could contribute to the national agenda to overcome health inequities, and to the future development of hospice care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.000 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.022 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".