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How is community based ‘out-of-hours’ care provided to patients with advanced illness near the end of life: A systematic review of care provision

Firth, Alice M.; Lin, Cheng Pei; Yi, Deok Hee; Goodrich, Joanna; Gaczkowska, Inez; Waite, Frances; Harding, Richard; Murtagh, Fliss E.M.; Evans, Catherine J.

Authors

Alice M. Firth

Cheng Pei Lin

Deok Hee Yi

Joanna Goodrich

Inez Gaczkowska

Frances Waite

Richard Harding

Catherine J. Evans



Abstract

Background: Deaths in the community are increasing. However, community palliative care out-of-hours is variable. We lack detailed understanding of how care is provided out-of-hours and the associated outcomes. Aim: To review systematically the components, outcomes and economic evaluation of community-based ‘out-of-hours’ care for patients near the end of life and their families. Design: Mixed method systematic narrative review. Narrative synthesis, development and application of a typology to categorise out-of-hours provision. Qualitative data were synthesised thematically and integrated at the level of interpretation and reporting. Data sources: Systematic review searching; MEDLINE, EMBASE, PsycINFO, CINAHL from January 1990 to 1st August 2022. Results: About 64 publications from 54 studies were synthesised (from 9259 retrieved). Two main themes were identified: (1) importance of being known to a service and (2) high-quality coordination of care. A typology of out-of-hours service provision was constructed using three overarching dimensions (service times, focus of team delivering the care and type of care delivered) resulting in 15 categories of care. Only nine papers were randomised control trials or controlled cohorts reporting outcomes. Evidence on effectiveness was apparent for providing 24/7 specialist palliative care with both hands-on clinical care and advisory care. Only nine publications reported economic evaluation. Conclusions: The typological framework allows models of out-of-hours care to be systematically defined and compared. We highlight the models of out-of-hours care which are linked with improvement of patient outcomes. There is a need for effectiveness and cost effectiveness studies which define and categorise out-of-hours care to allow thorough evaluation of services.

Citation

Firth, A. M., Lin, C. P., Yi, D. H., Goodrich, J., Gaczkowska, I., Waite, F., …Evans, C. J. (2023). How is community based ‘out-of-hours’ care provided to patients with advanced illness near the end of life: A systematic review of care provision. Palliative medicine, 37(3), 310-328. https://doi.org/10.1177/02692163231154760

Journal Article Type Review
Acceptance Date Jan 15, 2023
Online Publication Date Mar 16, 2023
Publication Date 2023-03
Deposit Date Apr 1, 2023
Publicly Available Date Mar 28, 2024
Journal Palliative Medicine
Print ISSN 0269-2163
Electronic ISSN 1477-030X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 37
Issue 3
Pages 310-328
DOI https://doi.org/10.1177/02692163231154760
Keywords Out-of-hours; After hours care; Out-of-hours medical care; Community health services; Palliative care; Systematic review
Public URL https://hull-repository.worktribe.com/output/4254632

Files

Accepted manuscript (2.5 Mb)
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Copyright Statement
Firth AM, Lin C-P, Yi DH, et al. How is community based ‘out-of-hours’ care provided to patients with advanced illness near the end of life: A systematic review of care provision. Palliative Medicine. 2023;37(3):310-328. © The Author(s) 2023. doi:10.1177/02692163231154760




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