Community out-of-hours palliative care – ‘It’s a patchwork of services’: A qualitative study exploring care provision

TY - JOUR

T1 - Community out-of-hours palliative care – ‘It’s a patchwork of services’

T2 - A qualitative study exploring care provision

AU - Firth, Alice M.

AU - Goodrich, Joanna

AU - Gaczkowska, Inez

AU - Harding, Richard

AU - Murtagh, Fliss E.M.

AU - Evans, Catherine J.

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2025/2

Y1 - 2025/2

N2 - Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals’ views on the barriers and facilitators to providing high quality community out-of-hours care. Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. Setting and participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) ‘It’s never one service’: challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) ‘We’re just plugging gaps’: prioritising patient care within limited resources. Patterns within the themes varied across the four models. Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors.

AB - Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals’ views on the barriers and facilitators to providing high quality community out-of-hours care. Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. Setting and participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) ‘It’s never one service’: challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) ‘We’re just plugging gaps’: prioritising patient care within limited resources. Patterns within the themes varied across the four models. Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors.

KW - After-hours care

KW - community health services

KW - models organisational

KW - palliative care

UR - http://www.scopus.com/inward/record.url?scp=85211645147&partnerID=8YFLogxK

U2 - 10.1177/02692163241302671

DO - 10.1177/02692163241302671

M3 - Article

C2 - 39660405

AN - SCOPUS:85211645147

SN - 0269-2163

VL - 39

SP - 245

EP - 255

JO - Palliative Medicine

JF - Palliative Medicine

IS - 2

ER -