Prospective randomized controlled trials are rarely suitable for the evaluation of new decision making techniques. An approach is described in which a cohort of patients is taken down the usual study pathway to the point at which the new technique would be used. Conventional decision rules are then applied and the results recorded. The new technique is then deployed and the cohort reclassified. The logical and statistical justification for this approach is outlined. More rapid (although possibly less pure) analysis of the effect of the new technique is achieved.

This study was designed to estimate the impact that lack of funding for shift care will have on the delivery of health care to palliative patients. A retrospective study of 274 palliative home care patients who all had access to shift nursing was conducted. A chart audit was employed to collect data. Eighty-one patients (29.6%) used 1,315 days of shift care. Three levels of care were used: support worker, registered nursing assistant, registered nurse. Seventy-three point seven per cent of shift care patients were able to die at home. Estimated costs were $292,386 per year. Shift care cost $2,309 per person, while hospital costs would be $5,893, a difference of $3,584. Seventeen point eight per cent of shift care is government funded; 82.2% of funding is unsecured. Twenty-five per cent of shift care patients have no private resources and may be forced unnecessarily into hospital. This results in: i) diminished quality of life for patient and family; ii) the potential for diminished quality of care; iii) ethical problems for society and the health delivery system; iv) unequal distribution and inappropriate use of health resources. Therefore the study concludes that palliative shift care should be fully funded.