Firth Alice M, Goodrich Joanna, Gaczkowska Inez, Harding Richard, Murtagh Fliss Em, Evans Catherine J
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute of Palliative Care Policy & Rehabilitation, London, UK.
Wolfson Palliative Care Research Centre, University of Hull, Hull, UK.
Palliat Med. 2025 Feb;39(2):245-255. doi: 10.1177/02692163241302671. Epub 2024 Dec 11.
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.
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.
Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis.
We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers.
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.
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.
接受社区姑息治疗的患者通常会接受一系列服务的护理，且需要全天候获得护理。然而，非工作时间的护理情况各不相同，人们对哪种护理模式最为理想了解甚少。
识别并描述英国当前非工作时间社区姑息治疗的模式，并探讨医疗保健专业人员对提供高质量社区非工作时间护理的障碍和促进因素的看法。
采用半结构化访谈的探索性定性研究，运用反思性主题分析法进行分析。
我们从20个地理区域招募了39名医疗保健专业人员。参与者包括社区姑息治疗、地区/社区护理和初级保健提供者的服务负责人。
确定了四种总体非工作时间姑息治疗模式，其特点是服务之间的整合程度、全科医生和专科医生提供者之间的平衡、护理的可及性以及提供的护理类型（实际临床护理/咨询护理）。对障碍和促进因素的分析产生了三个主题：（1）“从来都不是一项服务”：跨多个服务协调护理面临的挑战；（2）需要及时对痛苦症状进行专业管理；（3）“我们只是在填补空白”：在有限资源内优先考虑患者护理。这些主题中的模式在四种模式中各不相同。
本研究从专业人员的角度确定了四种常见非工作时间姑息治疗模式的关键特征。高质量非工作时间护理的促进因素包括：为患者提供特定的姑息治疗单一接入点；整合全科/专科服务的正式结构；以及及时/专业的症状管理。我们为纳入这些因素的潜在模式提供了建议。
