Over the coming years, as an ageing population with multiple chronic illnesses increases, the number of carers and paid carers is set to decrease. There is, therefore, an urgent need to understand what types of services are most supportive in helping to sustain caring relationships. Respite care is frequently mentioned as a key factor in supporting family carers and improving their quality of life but there is a lack of research to support its efficacy. This paper will present a conceptual map of respite care in order to promote a greater understanding of the multiple tensions that the palliative care respite literature reveals. As learning more about carer's needs and the complexities of the caring relationship develops, it is an appropriate time to map the key messages from the literature to help us understand what respite care does actually mean to palliative care service users and carers.

A reframing of respite care as an empathic response within a new palliative care approach is proposed. Within this, the centrality of the relationship is reinforced.

Introduction There are clear indications that over the coming years, an increasing amount of support for carers of patients with palliative care needs will be required. In recent UK policy and guidance respite care is frequently mentioned as a key factor in supporting carers. However, little is known about respite care services for people with palliative care needs and their carers and services appear to have developed on the assumption that they are a "good thing". This study addresses this gap in knowledge. It is located in a professional doctorate study where parallel application in practice is encouraged. Aims To explore the perspectives and experience of palliative care service users and carers of respite care. Method The participants were hospice service users and carers who had experienced respite care in that hospice and other settings. The approach was qualitative and data collection was carried out by unstructured informal interview and analysed in accordance with Grounded Theory strategies. Results Analysis of the data showed that there is nothing straightforward about respite care and the concepts of need and acceptance, vulnerability and resilience, risk and enablement, loss and gain all emerged. Discussion This study confi rmed that respite care suffers from a problem with defi nition and is often talked about in a trite way which doesn't refl ect the complexity of the caring relationship it is supposed to be sustaining. Conclusion Respite care is valued by palliative care service users and carers. The articulation of respite care needs and the insights gained in this study have the potential to infl uence practice and provide a platform for service development and improvement.

Background: Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting. Aim(s): To explore hospice staff and volunteers’ practice, its influences and what may need to change to improve hospice delirium care. Design: Qualitative interview study using behaviour change theory from a critical realist stance. Setting/participants: Thirty-seven staff, including different professional groups and roles, and volunteers were purposively sampled from two in-patient hospices. Results: We found that participants’ practice focus was on managing hyperactive symptoms of delirium, through medication use and non-pharmacological strategies. Delirium prevention, early recognition and hypoactive delirium received less attention. Our theoretically-informed analysis identified this focus was influenced by staff and volunteers’ emotional responses to the distress associated with hyperactive symptoms of delirium as well as understanding of delirium prevention, recognition and care, which varied between staff groups. Non-pharmacological delirium management was supported by adequate staffing levels, supportive team working and a culture of person-centred and family-centred care, although behaviours that disrupted the calm hospice environment challenged this. Conclusions: Our findings can inform hospice-tailored behaviour change interventions that develop a shared team understanding and engage staff’s emotional responses to improve delirium care. Reflective learning opportunities are needed that increase understanding of the potential to reduce patient distress through prevention and early recognition of delirium, as well as person-centred management. Organisational support for adequate, flexible staffing levels and supportive team working is required to support person-centred delirium care.

BackgroundUK policy and guidance frequently refers to respite care as a key factor in supporting carers. (NICE, 2004; Department of Health, 2005) However, little is known about respite care in palliative and end of life care and the role of hospices in providing respite care. (Wolkowski & Carr, 2017; Vandepitte et al., 2016; Wolkowski et al., 2010). Dove House Hospice (DHH) in Hull provides respite care. Our observation is that the needs of both the patient and carer are frequently complex and patients are often highly dependent, with a high level of nursing and sometimes medical needs.AimsTo increase our understanding of the characteristics of respite care patients and carers with a view to articulating the need for hospice respite care, its benefits and potential benefits.MethodsA retrospective audit of records of respite care patients (2015–2016) was carried out. A simple data collection tool, organised on a Microsoft Excel spread sheet was used to extract and analyse data. Data collected included demographic and patient characteristics, diagnosis and condition background, referral/admission details, living arrangements and outcome of admission.ResultsThe majority of the 90 patients admitted for respite care were male (58%). Complex neurological disorders were the leading background diagnosis (28%) among the 16 diagnosis groups identified. Most referrals were from the community services or from patients and their families. Although most patients, 80%, were discharged home after respite, about 12% died during the course of the respite. As this was a retrospective audit, we could not examine quality of care or impact of the intervention on patients or carers because the information was not available.ConclusionThe audit has enhanced our understanding of respite care patients and their carers. Results from this audit will provide a platform for further enquiry helping to guide and improve service provision.