How is community based ‘out-of-hours’ care provided to patients with advanced illness near the end of life: A systematic review of care provision

Abstract

Background: Deaths in the community are increasing. However, community palliative care out-of-hours is variable. We lack detailed understanding of how care is provided out-of-hours and the associated outcomes. Aim: To review systematically the components, outcomes and economic evaluation of community-based ‘out-of-hours’ care for patients near the end of life and their families. Design: Mixed method systematic narrative review. Narrative synthesis, development and application of a typology to categorise out-of-hours provision. Qualitative data were synthesised thematically and integrated at the level of interpretation and reporting. Data sources: Systematic review searching; MEDLINE, EMBASE, PsycINFO, CINAHL from January 1990 to 1st August 2022. Results: About 64 publications from 54 studies were synthesised (from 9259 retrieved). Two main themes were identified: (1) importance of being known to a service and (2) high-quality coordination of care. A typology of out-of-hours service provision was constructed using three overarching dimensions (service times, focus of team delivering the care and type of care delivered) resulting in 15 categories of care. Only nine papers were randomised control trials or controlled cohorts reporting outcomes. Evidence on effectiveness was apparent for providing 24/7 specialist palliative care with both hands-on clinical care and advisory care. Only nine publications reported economic evaluation. Conclusions: The typological framework allows models of out-of-hours care to be systematically defined and compared. We highlight the models of out-of-hours care which are linked with improvement of patient outcomes. There is a need for effectiveness and cost effectiveness studies which define and categorise out-of-hours care to allow thorough evaluation of services.

Understanding patient and family utilisation of community-based palliative care services out-of-hours: Additional analysis of systematic review evidence using narrative synthesis

“…From 64 papers included in the original review [ 22 ], 31 reported data on use of out-of-hours services from ten different countries ( Table 1 ). 33 provided no information on the use of services, and were therefore excluded from the analysis.…”

“…Our original systematic review of models of out-of-hours services [ 22 ] found improved patient outcomes for community out-of- hours services provided 24/7 by specialist palliative care services offering both hands-on clinical care and advisory care. However, resources are limited, notably workforce shortages, meaning that this model is not always feasible.…”

“…This review is an additional analysis of a recently completed systematic review that examined the components, outcomes, and economic evaluation of community-based ‘out-of-hours’ care for patients near the end of life and their families [ 22 ].…”

“…A two-stage search strategy was used: first a search of four electronic databases MEDLINE, EMBASE, PsycINFO and CINAHL between 1 st January 1990 to 1 st August 2022 was undertaken, and then a second search strategy involved identification of trials on home-based out-of-hours palliative care included in the Cochrane review of home-based palliative care [ 6 ]. Further details, including MeSH and keyword terms, inclusion and exclusion criteria and quality assessment, are published elsewhere [ 22 ].…”

“…Our original systematic review synthesised evidence on the components, outcomes, and economic evaluation of community-based ‘out-of-hours’ care for patients near the end of life and their families [ 22 ]. However, there was not scope to report on service utilisation in detail.…”