CARE-PAC: The Care and Support System for Patients and Carers receiving palliative and end-of life-care

Research Question: How can the CARE-PAC system be further developed, implemented, and evaluated to assess its clinical efficacy and cost-effectiveness, to support its commercialisation and adoption within the health and care system? Background: The demand for palliative and end-of-life care (PEOLC) is projected to rise by 42% by 2040 due to an aging population and rising chronic illnesses. This surge is putting pressure on the UK healthcare system, with spending on individuals in their final year of life totalling £11.7bn, primarily on hospital care (£9.6bn). Limited access to community-based services forces many to rely on emergency care and hospital admissions, leading to fragmented care and poor communication. Carers, who are critical in supporting individuals at the end of life, face significant emotional and physical strain, exacerbated by the lack of coordinated care. Remote monitoring enables real-time tracking of symptoms and needs to support early intervention and anticipatory care. CARE-PAC (Care for Advanced, Responsive, Early intervention for Patients And Carers) has been developed specifically for end-of-life care to provide personalised support for patients and carers. By identifying needs early and offering tailored self-care advice, CARE-PAC aims to prevent crisis points, reduce hospital admissions, and improve outcomes for both patients and carers. Aim: To further develop, implement, and evaluate the pre-commercial version of CARE-PAC, focusing on its clinical efficacy, cost-effectiveness, and the development of an implementation plan to support its adoption and commercialisation within the health and care system. Methods: Co-Design & System Development: A participatory approach will refine CARE-PAC s functionality, user interface, and clinical workflows. Workshops and usability testing with patients, carers, and healthcare professionals will ensure the system meets users needs, particularly in supporting carers and alleviating their burden. Technical Advancements: CARE-PAC will undergo iterative improvements including optimisation of alert algorithms, and enhancements to the decision-support dashboard for efficient triaging. These upgrades aim to improve responsiveness and clinical utility. Randomised Controlled Trial: A multi-site RCT will assess CARE-PAC s clinical efficacy and cost-effectiveness. The intervention group will use CARE-PAC alongside standard care, while the control group will receive standard care. Outcomes including symptom burden, quality of life, carer distress, healthcare utilisation, and cost-effectiveness. Implementation Toolkit: An implementation toolkit will be co-developed with stakeholders, providing guidance on integrating CARE-PAC into clinical pathways, training materials, and strategies to ensure scaling up and long-term sustainability Timelines for Delivery: The project will span three years, with Year 1 focused on co-design and system development, followed by the RCT and evaluation in Years 2–3. Anticipated Impact and Dissemination: This project aims to deliver CARE-PAC as a scalable, evidence-based remote monitoring solution for integration into diverse health and care systems. By enabling timely interventions and reducing hospital admissions, CARE-PAC could improve patient care, reduce health and care costs, and alleviate the physical and emotional burden on carers. The findings will contribute to the growing evidence supporting remote monitoring in palliative and end-of-life care. Results will be disseminated through academic publications, conferences, and stakeholder engagement, facilitating wider adoption and commercialisation of CARE-PAC.