A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Abstract

Background: People with palliative and end-of-life care needs in the community and their carers often rely on out-of-hours services to remain at home. Policymakers internationally have recommended implementation of telephone advice lines to ensure 24-hour access to support. However, little is known about their effectiveness. Aim: To review the evidence for the clinical and cost effectiveness of out-of-hours- telephone advice lines for adults with palliative care needs living at home and their carers, and report service characteristics associated with effectiveness. Design: Rapid systematic review, with narrative synthesis (PROSPERO ID: CRD42023400370). Data sources: Three databases (Medline, EMBASE, CINAHL) were searched in February 2023 for studies reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Twenty-one studies, published 2000-2022, were included. Most studies were observational; none were experimental. Three were comparative, and seven lacked explicit research questions or methods. Results were largely descriptive, focusing on service development and use, and process measures. Patient and carer outcomes were primarily reported qualitatively. Only two studies investigated possible system outcomes, by examining care-seeking behaviour after using telephone advice lines. Conclusion: Existing evidence for the effectiveness of telephone advice lines is limited. The lack of experimental studies evaluating individual or system-level outcomes prevents assessment of the effectiveness/cost-effectiveness of service models. There is a clear need for more rigorous evaluations using consistent reporting, and inclusion of patient and carer perspectives during both development and implementation. Recommendations for future evaluations are provided.

Telephone advice lines available out-of-hours to people with palliative and end-of-life care needs: a qualitative interview study with professionals and development of a practical framework to improve services

“…choosing meaningful patient and carer outcomes rather than focusing on service utilisation). [42][43][44] Our interviews indicated that some initiatives were short-lived or developed in response to the pandemic.…”

“…2,47,48 Incorporating patients and carer priorities/preferences in the planning and development of out-of-hours palliative care services is essential to ensuring that care is patient-centred and addresses safety concerns, and has seldom been done with dedicated advice lines. 44,49 Therefore, we conducted a PPI workshop and integrated reflections on the evidence provided by professionals.…”

“…24 Since, our understanding of advice lines has advanced on a small scale via audits/evaluations , and remains largely descriptive. 14,32,44,[50][51][52][53][54] Our framework is directly informed by evidence and intended to facilitate more effective approaches to developing, enabling and evaluating such services. It may also help to understand where variations and inequalities exist.…”

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

“…choosing meaningful patient and family carer outcomes rather than focussing on service utilisation). [54][55][56] Our interviews indicated that some initiatives were short-lived or developed in response to the pandemic. Palliative care services have demonstrated considerable flexibility and 'frugal' innovation in the context of the pandemic, 57 but the longevity of these initiatives are important to consider.…”

“…2,42,59 Incorporating patients and family carer priorities/preferences in the planning and development of outof-hours palliative care services is essential to ensuring that care is person-centred and addresses safety concerns, and has seldom been done with dedicated advice lines. 56,60 Therefore, we conducted a PPI workshop and integrated reflections on the evidence provided by professionals.…”