The NIHR Health Technology Assessment (HTA) Programme is looking to fund research about specialist palliative care support in care home settings.
This is a 2-stage, commissioned funding opportunity. To apply for the first stage you should submit an outline application. If invited to the second stage, you will then need to complete a full application.
Introduction
Our Health Technology Assessment Programme invites applications in response to specific research questions and priorities. These have been identified, developed and prioritised for their importance to stakeholders including:
- Department of Health and Social Care
- NHS
- patients and public
- local government
Research question
What is the effectiveness and cost-effectiveness of providing the specialist palliative care support, Palliative Care Needs Rounds, in UK residential care homes?
Target group: Residents at risk of dying without a plan in place residing in a residential care home for older people and their paid carers.
Applications are encouraged which include recruitment from geographic populations with high levels of need which have been historically underserved by research activity in this field.
Intervention: Palliative Care Needs Rounds (applicants should specify how this will be adapted to a UK setting and define using the Template for Intervention Description and Replication (TIDieR) guidelines).
Comparator: Current standard of care (applicants should define using the Template for Intervention Description and Replication (TIDieR) guidelines).
Important outcomes: Staff and family perceptions of residents’ quality of death, cost-effectiveness (to include impact of ambulance usage on NHS spend, and a measure of cost to the care homes in terms of staff time).
Other outcomes: Care home staff and family carer confidence in death literacy, rates of hospital admission/length of stay in hospital acute care, level of completion of advance care planning, acceptability to care home operators.
Existing core outcomes should be included amongst the list of outcomes unless a good rationale is provided to do otherwise. Applicants should consider reporting recruitment and findings disaggregated by sex and other demographic factors where relevant.
Study design
A cluster randomised controlled trial with an internal pilot phase to test key trial processes such as recruitment, retention, and adherence. Clear stop/go criteria should be provided to inform progression from pilot to full trial.
Applicants are encouraged to consider the size, type of residential care home (personal care/nursing/dementia care/dual-registered), and CQC rating of care homes when designing the randomisation process.
Applicants may wish to consider a stepped-wedge design, taking into account how this type of trial design will affect the delivery time for the trial.
Applicants are encouraged to consider the value of an embedded process evaluation in this research, to identify factors such as barriers and facilitators to implementation, and stakeholder views on the impact of the intervention on the decision-making processes around hospitalisations and decisions to seek additional healthcare advice or conveyance.
Minimum duration of follow-up: Applicants to define and justify.
Longer-term follow up: If appropriate, researchers should consider obtaining consent to allow potential future follow up through efficient means (such as routine data) as part of a separately funded study.
Setting: Residential care homes for older people, potentially including nursing/dementia care/dual-registered homes.
Applicants are encouraged to engage with the relevant Research Support Service (RSS), who are able to support researchers in developing their applications. The Research Support Service hosts the Research Support Service Specialist Centre for Social Care.
The RSS is a national service, and each hub and Specialist Centre is open to researchers based anywhere in England. The RSS can support researchers in the devolved nations if they are working in collaboration with English partners.
It is advisable that studies involving a trial have also engaged with an accredited Clinical Trials Unit (CTU).
Rationale
As the UK population ages, more people are living and subsequently dying in residential care homes. These residents often have complex health needs and are at high risk of being admitted to hospital in the final months of their life. Many of these hospital stays could be avoided with the right support in place. Unnecessary admissions can cause distress for residents and families, may lead to treatments that offer little benefit, and place avoidable pressure on NHS services. Despite their passion and commitment, care home staff frequently report that they feel unprepared to recognise when a resident, who is deteriorating or nearing the end of life, needs to go to the hospital, and often lack the confidence or specialist training needed for difficult conversations and planning ahead. This highlights a major gap in end-of-life care in the UK and a clear need for new, evidence-based approaches.
One promising approach is Palliative Care Needs Rounds (“Needs Rounds”) – a structured, specialist-led programme first developed and tested in Australia. Needs Rounds involve monthly meetings led by a palliative care specialist to identify residents at risk of dying without a plan in place, provide tailored education to staff, and facilitate discussions with families about goals of care. Research from Australia suggests that this approach reduces both the length of hospital stays and the rate of hospital admissions, improving residents’ end-of-life experience while also reducing costs to the health system.
However, the UK residential care home sector differs from Australia’s. Care homes in the UK are generally smaller, may not have registered nurses on-site, and staff receive different levels of training. This means that it cannot be assumed that an intervention shown to work in Australia will work in the same way in the UK. Early work in the UK, funded by the NIHR, shows that Needs Rounds strengthen collaboration between care home and palliative care teams, increase staff confidence, and help more residents to be cared for and die in their preferred place.
To support evidence based practice, this research specification proposes a large UK randomised controlled trial looking at the effectiveness and cost-effectiveness of Needs Rounds, to assess whether the intervention remains effective in a UK setting.
Funding opportunity scope
This is a focused funding opportunity where our intention is to fund a single study.
Outputs
Pathways to impact – we are focused on the impact of the research we fund. Applicants are asked to consider the timing and nature of deliverables in your proposals; and encouraged to maximise the impact of your research by explaining how you will mobilise knowledge and ensure that it is useful and relevant to stakeholders such as:
- policy makers
- special interest groups
- charities
- community audiences
- other stakeholders
Duration and costs
You are advised that we are custodians of public funds and value for money is a key criteria that peer reviewers and funding committee members will assess applications against.
Eligibility
Please refer to the overview tab for the funding opportunity specific eligibility.
Inclusive research
You must detail how you have considered inclusive research design and sex and gender throughout the whole research lifecycle and provide information on any associated costs. For full details see: Research inclusion funding application guidance
Supporting information
A background document is available that provides further information to support your application. It is intended to summarise what prompted the funding opportunity and the existing evidence base, including relevant work from the HTA and the wider NIHR research portfolio. It was researched and written based on information obtained from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy, please email htaresearchers@nihr.ac.uk.
Visit funding web page
(https://www.nihr.ac.uk/funding/what-effectiveness-and-cost-effectiveness-specialist-palliative-care-support-care-home-settings/2026381)
