Out-of-hours community palliative care: a national survey of hospice providers

Bereaved carers' experiences of a partnership model of after-hours and extended palliative care delivery in rural Australia

BACKGROUND

Caregivers are fundamental to achieving effective home-based palliative care. Lack of access to after-hours visiting palliative care and non-clinical home support in rural areas increases caregiver burden, unplanned hospital admissions and impacts patients' ability to die at home. To support end-of-life care at home, the New South Wales Government endorsed partnership models between specialist community-based palliative services and non-government organisations to provide end of life support packages to enhance after-hours access and non-clinical support.

AIM

To explore bereaved rural carers' experiences of supporting dying at home within this model.

METHOD

Bereaved carers accessing lend of life support packages were purposively recruited. A total of 10 semi-structured interviews were conducted. Data was thematically analysed using interpretive phenomenological analysis. The COnsolidated criteria for REporting Qualitative research (COREQ) framework guided study reporting.

FINDINGS

Collaboration, after-hours visiting access and extended non-clinical support facilitated end-of-life care at the patient's home. Participants of the study had a positive experience of this partnership.

CONCLUSION

This integrative model addressed existing service gaps, maximised carer support and facilitated home deaths. Further public policy, funding and research is needed to support integrated rural palliative care models.

The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review

BACKGROUND

People with palliative care needs and their carers often rely on out-of-hours services to remain at home. Policymakers have recommended implementing telephone advice lines to ensure 24/7 access to support. However, the impact of these services on patient and carer outcomes, as well as the health care system, remains poorly understood.

AIM

To evaluate the clinical- and cost-effectiveness of out-of-hours palliative care telephone advice lines, and to identify service characteristics associated with effectiveness.

DESIGN

Rapid systematic review (PROSPERO ID: CRD42023400370) with narrative synthesis.

DATA SOURCES

Three databases (Medline, EMBASE and CINAHL) were searched in February 2023 for studies of any design reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool, and quantitative and qualitative data were synthesised narratively.

RESULTS

Twenty-one studies, published 2000-2022, were included. Most studies were observational, none were experimental. While some evidence suggested that telephone advice lines offer guidance and reassurance, supporting care at home and potentially reducing avoidable emergency care use in the last months of life, variability in reporting and poor methodological quality across studies limit our understanding of patient/carer and health care system outcomes.

CONCLUSION

Despite their increasing use, evidence for the clinical- and cost-effectiveness of palliative care telephone advice lines remains limited, primarily due to the lack of robust comparative studies. There is a need for more rigorous evaluations incorporating experimental or quasi-experimental methods and longer follow-up, and standardised reporting of telephone advice line models and outcomes, to guide policy and practice.

Telephone advice lines for adults with advanced illness and their family carers: a qualitative analysis and novel practical framework

BACKGROUND

Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care.

AIM

To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services.

DESIGN

A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework.

SETTING/PARTICIPANTS

Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled.

RESULTS

Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations.

CONCLUSIONS

Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.