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

Area of Science:

• Palliative Care Research
• Healthcare Service Delivery Models
• Qualitative Health Research

Background:

• Community palliative care patients require 24/7 access to services.
• Current out-of-hours (OOH) community palliative care models are varied and not well understood.
• Optimal models for OOH community palliative care are yet to be determined.

Purpose of the Study:

• To identify and characterize existing OOH community palliative care models in the UK.
• To explore healthcare professionals' perspectives on barriers and facilitators to high-quality OOH care.
• To inform the development of improved OOH palliative care service delivery.

Main Methods:

• An exploratory qualitative study design was employed.
• Semi-structured interviews were conducted with 39 healthcare professionals.
• Reflexive thematic analysis was used to analyze interview data.

Main Results:

• Four distinct OOH palliative care models were identified, varying in service integration, provider balance (generalist/specialist), and care type (clinical/advisory).
• Key barriers included challenges in coordinating multi-service care, the need for timely symptom management, and resource limitations.
• Facilitators for high-quality OOH care involved a single point of access, integrated service structures, and skilled symptom management.

Conclusions:

• Four models of OOH community palliative care were characterized from healthcare professional perspectives.
• Key facilitators for optimal OOH care include integrated services and effective symptom management.
• Recommendations are provided for a potential model to enhance OOH palliative care delivery.