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

Firth, Alice M.; Goodrich, Joanna; Gaczkowska, Inez; Harding, Richard; Murtagh, Fliss E.M.; Evans, Catherine J.

Abstract

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.

Citation

Firth, A. M., Goodrich, J., Gaczkowska, I., Harding, R., Murtagh, F. E., & Evans, C. J. (in press). Community out-of-hours palliative care – ‘It’s a patchwork of services’: A qualitative study exploring care provision. Palliative medicine, https://doi.org/10.1177/02692163241302671

• Journal Article Type: Article
• Acceptance Date: Nov 2, 2024
• Online Publication Date: Dec 11, 2024
• Deposit Date: Dec 31, 2024
• Publicly Available Date: Jan 3, 2025
• Journal: Palliative Medicine
• Print ISSN: 0269-2163
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/02692163241302671
• Keywords: After-hours care; Palliative care; Community health services; Models organisational
• Public URL: https://hull-repository.worktribe.com/output/4966651