The Effect of Community-Based Specialist Palliative Care Teams on Place of Care

BACKGROUND: Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death.

OBJECTIVE: The study objective was to examine the place of care in the last 30 days of life.

METHODS: In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort.

RESULTS: After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p < 0.001) than the unexposed group. On the last day of life (place of death), the exposed group had 18% die in an in-patient hospital bed compared to 29% in usual care.

CONCLUSION: Examining place of care in the last month can effectively illustrate the service use trajectory over time.

EU Cross-Border Cooperation and Conflict Transformation in the Basque and Irish Border Regions

Comparative research on violent conflict in the Basque Country and Ireland has yielded a sizable body of published academic work. Less well explored is the relationship between conflict transformation and cross-border cooperation in that specific comparative context. This paper provides a comparative examination of Third (not for profit) sector cross-border cooperation as conflict transformation in the Basque (France/Spain) and Irish (UK/Ireland) border regions. To what extent does cross-border cooperation contribute to peacebuilding in the two last violent ethnonationalist conflicts in Western Europe? The comparison is based on the premise that the EU played a different role in both cases. In the Irish case, the EU contributed to the institutionalization of a peace process that included cross-border cooperation between third sector organizations among the policy instruments contributing to conflict transformation. In the Basque case, the unilateral renunciation of violence by ETA (Euskadi eta Askatasuna) in 2010 did not generate the consistent involvement of the EU in a comparable institutional peace process. However, some third sector organizations used EU instruments for cross-border economic, social and cultural cooperation between France and Spain in order to reinforce their cross-border networks, which indirectly impacted on conflict transformation. The effectiveness of this cross-border cooperation for conflict transformation is assessed comparatively. To what extent does this increase in cross-border cooperation “from below” connect to wider institutional and social processes of conflict transformation in Ireland and the Basque Country? Crucially, does the strengthening of cross-border relations on shared issues mollify or sharpen existing identity cleavages? Also considered is the sustainability of such cooperation in these regions in light of the less favourable post-2004 EU funding environment, and the post-2008 economic and political turmoil affecting the relevant EU member states, especially Ireland and Spain.