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

Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal.

Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals' views on the barriers and facilitators to providing high quality community out-of-hours care.

Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis.

Setting And Participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers.

Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) 'It's never one service': challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) 'We're just plugging gaps': prioritising patient care within limited resources. Patterns within the themes varied across the four models.

Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors.