Early identification of patients with palliative care needs
| ISRCTN | ISRCTN57720352 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN57720352 |
| Integrated Research Application System (IRAS) | 324092 |
| Central Portfolio Management System (CPMS) | 69368 |
| Sponsor | Northern Care Alliance NHS Foundation Trust |
| Funder | Greater Manchester and East Cheshire Strategic Clinical Network (palliative care) |
- Submission date
- 30/04/2026
- Registration date
- 14/05/2026
- Last edited
- 03/06/2026
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Injury, Occupational Diseases, Poisoning
Plain English summary of protocol
Background and study aims
This study is exploring the accuracy of a digital tool (the HOMR Now! Tool) which may be able to help doctors recognise when someone is at higher risk of dying within the next year.
It is accepted that an important part of a healthcare professional’s role is to identify when a person is at risk of becoming seriously unwell, such that they can be offered the best possible support and most personalised care. Research has shown however, that people approaching the end of their life are often offered relevant information, choices and support only at a late stage in their illness.
The study will test whether a digital tool called HOMR Now! can flag hospital patients at higher risk of dying within the next year, which if used in future use could help:
• Prompt conversations about care preferences at the most helpful time
• Ensure patients receive the right support when they need it
• Improve quality of life in the final year
Who can participate?
People who have had experience of being in hospital or supporting a friend or relative in hospital in the last 10 years, and health professionals working in the acute hospital setting.
What does the study involve?
By running the HOMR Now! tool on past patient records, the study will check how accurately it predicts who might benefit from earlier palliative care discussions. It’s important to say that at this stage, the tool won’t affect anyone’s treatment or care - the study is first checking that it works as expected, and any use in practice would be a separate future project. Then the study will ensure that patients, those important to them and health professionals are fully consulted with, to seek opinions on using a tool like HOMR Now! and are therefore running focus groups to gather this information.
The final part of this study is to look at the education, support and training requirements health professionals might need to help them safely and effectively use a digital tool like HOMR Now!
What are the possible risks and benefits of participating?
There are no direct benefits to participants from taking part. It is hoped that understanding the acceptability of the HOMR Now! tool may lead to further research which improves practice in palliative care and which may benefit patients, carers/family members and clinicians.
Due to the sensitive nature of the topics which may be discussed, some people may experience discomfort (mental, emotional or physical) or distress as part of the research. If any of the discussions upset a participant, the study will pause the focus group discussion and the researchers will provide support. The researchers will be able to refer participants to relevant supportive services. Volunteers don’t have to answer any questions that you may be uncomfortable with.
Where is the study run from?
This study is sponsored by the Northern Care Alliance NHS Foundation Trust and focus groups will be run at 3 NHS Acute hospital sites in Bolton, Salford and Wigan, UK.
When is the study starting and how long is it expected to run for?
Participants will be approached in April and May 2026 for participation in focus groups over subsequent months. The study will close following completion of all elements, which is anticipated by 31/12/2026.
Who is funding the study?
This study has been supported with funding from the Greater Manchester and Eastern Cheshire Strategic Clinical Network (palliative care).
Who is the main contact?
Dr Tim Jackson (Chief investigator), tim.jackson@nca.nhs.uk
Contact information
Public, Scientific, Principal investigator
Salford Royal Hospital
Stott Lane
Salford
M6 8HD
United Kingdom
| Phone | +44 0161 206 4609 |
|---|---|
| tim.jackson@nca.nhs.uk |
Study information
| Primary study design | Observational |
|---|---|
| Observational study design | Cohort study |
| Scientific title | Early identification of patients with palliative care needs in the acute hospital setting - Evaluation of a digital mortality prediction tool and clinician training needs |
| Study objectives | Patients with life-limiting illnesses and palliative care needs are often identified late in the course of their disease, with limited opportunities remaining to plan care towards the end of their lives in the way they would wish. This project includes quantitative and qualitative evaluation of an innovative tool (the Hospital One-year Mortality Risk, "HOMR Now!") which flags patients after admission to hospital who are most at risk of death in the following year. The tool gives a risk score, with the aim that patients exceeding a chosen score would be flagged to clinicians for consideration of referral to palliative care services and/or support with future planning etc. if the clinician feels this is appropriate. Whilst the tool has been validated in Canada, we are unaware of any similar tool in use in a UK hospital setting and this could significantly change practice within hospital-based palliative care. The study aims to evaluate the accuracy of the HOMR Now! tool in the UK setting using a retrospective cohort analysis. The study also aims to review the acceptability of using a predictive digital tool in this way, through the running of focus groups with patients, carers and health professionals. Finally, the study aims to evaluate what measures would be required to support staff in the implementation and use of such a tool in future, through the use of a training needs analysis questionnaire. |
| Ethics approval(s) |
Approved 24/11/2025, London - Brighton and Sussex REC (2 Redman Place, Stratford, London, E20 1JQ, United Kingdom; +44 0207 104 8000; brightonandsussex.rec@hra.nhs.uk), ref: 25/LO/0622 |
| Health condition(s) or problem(s) studied | Identification of patients who may need palliative care assessment or intervention following admission to an acute hospital. |
| Methodology | This is a retrospective cohort study with qualitative elements (focus groups and training needs analysis questionnaire). The quantitative element of this project will calculate the HOMR Now! score for a cohort of patients previously admitted to hospital at 3 UK NHS acute hospital sites. There will be follow-up at one year to evaluate the predictive accuracy of the score. Baseline data will be collected on whether these patients were referred to palliative care services or had advance care planning. The software developed to apply the HOMR Now! algorithm will not be used for any medical or interventional purpose in this study but solely to address the principal research question. There will be no change to clinical management for these patients, however the study may lead on to a future separate research proposal examining prospective use of the HOMR Now! tool. Qualitative evaluation will comprise focus groups with clinicians, patients and carers/family. These will gather in-depth, rich data to help evaluate the acceptability of using such a clinical tool. A training needs analysis will also examine staff learning needs required to support any potential future implementation study. |
| Intervention type | Other |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) | |
| Completion date | 31/12/2026 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 18 Years |
| Upper age limit | 120 Years |
| Sex | All |
| Target sample size at registration | 36 |
| Key inclusion criteria | For focus groups: 1. Patients who have been admitted to hospital in the last 10 years 2. Carers/relatives of patients who have had a hospital admission in the last 10 years 3. Age over 18 4. Health professionals working in the acute hospital setting at any of the registered study sites |
| Key exclusion criteria | 1. Patients lacking mental capacity to consent to involvement 2. Patients under 18 years of age |
| Date of first enrolment | 05/05/2026 |
| Date of final enrolment | 01/09/2026 |
Locations
Countries of recruitment
- United Kingdom
- England
Study participating centres
Stott Lane
Salford
M6 8HD
England
Wigan
WN1 2NN
England
Minerva Road
Farnworth
Bolton
BL4 0JR
England
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Editorial Notes
03/06/2026: Internal review.
20/05/2026: The date of final enrolment was changed from 30/09/2026 to 01/09/2026.
30/04/2026: Study's existence confirmed by Health Research Authority (HRA) (UK).
