Out-of-hours palliative care: a qualitative study of cancer patients, carers and professionals.
BACKGROUND
New out-of-hours healthcare services in the UK are intended to offer simple, convenient access and effective triage. They may be unsatisfactory for patients with complex needs, where continuity of care is important.


OBJECTIVE
To explore the experiences and perceptions of out-of-hours care of patients with advanced cancer, and with their informal and professional carers.


METHODS
Qualitative, community-based study using in-depth interviews, focus groups and telephone interviews.


METHODS
Urban, semi-urban and rural communities in three areas of Scotland.


METHODS
Interviews with 36 patients with advanced cancer who had recently used out-of-hours services, and/or their carers, with eight focus groups with patients and carers and 50 telephone interviews with the patient's GP and other key professionals.


RESULTS
Patients and carers had difficulty deciding whether to call out-of-hours services, due to anxiety about the legitimacy of need, reluctance to bother the doctor, and perceptions of triage as blocking access to care and out-of-hours care as impersonal. Positive experiences related to effective planning, particularly transfer of information, and empathic responses from staff. Professionals expressed concern about delivering good palliative care within the constraints of a generic acute service, and problems accessing other health and social care services.


CONCLUSIONS
Service configuration and access to care is based predominantly on acute illness situations and biomedical criteria. These do not take account of the complex needs associated with palliative and end-of-life care. Specific arrangements are needed to ensure that appropriately resourced and integrated out-of-hours care is made accessible to such patient groups.
Worth
Allison
A
Cancer Care Research Centre, University of Stirling, Stirling, Scotland FK9 4LA, UK. Allison.Worth@stir.ac.uk
Boyd
Kirsty
K
Kendall
Marilyn
M
Heaney
David
D
Macleod
Una
U
Cormie
Paul
P
Hockley
Jo
J
Murray
Scott
S
D000328:Adult; D039602:After-Hours Care / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017028:Caregivers; D005260:Female; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D019452:Terminally Ill