Introduction Although people with advanced illness increasingly die at home, we lack a detailed understanding of how community palliative care outside normal working hours (‘out-of-hours’) is provided. It appears to be highly variable. The lack of description around ‘out-of-hours’ models leads to poor quality service evaluations.
Aims To review systematically, the evidence for models of out-of-hours community care for patients with advanced illness near the end of life and their families. To construct a typological framework of different categories of service provision.
Method A systematic narrative review using a two-stage search strategy: 1) Four databases searched (1990-2019). Studies reported processes and/or outcomes around the delivery of out-of-hours palliative care. 2) Update of Cochrane review (2010) on home-based palliative care to identify trials including out-of-hours care. Components of the out-of-hours care were extracted and narrative synthesis used to construct a typology of out-of-hours care.
Results 61 papers met eligibility criteria. Three over-arching components were identified to characterise different categories, comprising: 1. service times (24/7 or out-of-hours only service), 2. focus of team delivering the care (specialist palliative care/dedicated palliative care, general palliative care or integrated specialist/general) and 3. type of care delivered (hands-on or advisory). These components were used to create a multi-dimensional typology and 15 categories of services were created. Overall, the models of out-of-hours care reported lacked description. Only 8 studies evaluated the impact of the out-of-hours service models on stated outcomes. Most frequently reported outcomes were place of death and service use.
Conclusion A novel typology to understand, classify, and compare out-of-hours community-based care has been constructed. Under-reporting of the different components of out-of-hours care alongside meaningful outcomes is a barrier to the development of the science in this crucial aspect of palliative care delivery.
Impact This well-defined typology of out-of-hours services for palliative care patients provides a systematic understanding of which models of service provision are available to patients and their families. It can be used to accurately describe a range of models or care and will enable comparisons of similarity/dissimilarity of service provision out-of-hours.
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