McEwan Kathryn, Atkinson Joanne, Clarke Amanda, Bate Angela, Jeffery Caroline, Dalkin Sonia
University of Northumbria, Newcastle upon Tyne, England.
BMC Palliat Care. 2025 Jul 14;24(1):199. doi: 10.1186/s12904-025-01826-y.
Rapid response services (RRS) support patients who wish to die at home, providing flexible, timely, and specialist care. These services are regionally variable yet are valued by patients and caregivers in often uncertain end-of-life situations. Research on their effectiveness and implementation to date is limited. This study explores how RRS are experienced in practice and identifies key contexts and mechanisms underpinning their impact.
This study aimed to understand how different service models of RRS function, who they work for, how and why. By exploring patient, caregiver, and staff perspectives, we sought to refine programme theories and provide evidence-based recommendations for service improvement and policy development.
A realist evaluation approach was used to examine how, why, and in what contexts RRS provide end-of-life care. Through iterative theory development and refinement, we identified key generative mechanisms and the contexts in which they trigger outcomes.
Qualitative data were collected via realist theory driven semi-structured focus groups and interviews with 36 participants across two sites, each operating a distinct RRS model. Data were analysed using a retroductive context-mechanism-outcome (CMO) framework and informed by Transitions Theory.
Six programme theories were developed, highlighting the central role of continuity of care in enabling positive end-of-life experiences. A sense of 'being known' by RRS staff facilitated smooth transitions, reduced distress, and fostered trust. Timely, responsive care, particularly at night, was valued, whereas gatekeeping, fragmented service models, and inequities in access (especially for non-cancer patients) created barriers.
Patients and caregivers valued holistic, relationship-centred care that provided emotional security alongside practical support. However, service inconsistencies, late transitions into palliative care, and systemic inequities limit accessibility. Findings highlight the need for early engagement, integrated service models, and 24/7 specialist care, ensuring greater continuity and equity in home-based end-of-life care.
快速反应服务（RRS）为希望在家中离世的患者提供支持，提供灵活、及时且专业的护理。这些服务在地区上存在差异，但在往往不确定的临终情况下受到患者和护理人员的重视。迄今为止，关于其有效性和实施情况的研究有限。本研究探讨了RRS在实际中的体验方式，并确定了支撑其影响的关键背景和机制。
本研究旨在了解RRS的不同服务模式如何运作、服务对象是谁、如何运作以及为何如此。通过探索患者、护理人员和工作人员的观点，我们试图完善项目理论，并为服务改进和政策制定提供基于证据的建议。
采用现实主义评估方法来研究RRS在何种情况下、为何以及如何提供临终护理。通过迭代的理论发展和完善，我们确定了关键的生成机制以及它们触发结果的背景。
通过现实主义理论驱动的半结构化焦点小组和对两个地点的36名参与者进行访谈收集定性数据，每个地点都采用不同的RRS模式。使用逆向推理的背景-机制-结果（CMO）框架对数据进行分析，并以转变理论为依据。
形成了六个项目理论，突出了护理连续性在实现积极临终体验中的核心作用。RRS工作人员的“被了解感”有助于顺利过渡、减轻痛苦并增进信任。及时、响应迅速的护理，尤其是在夜间，受到重视，而把关、分散的服务模式以及获取服务的不平等（特别是对非癌症患者而言）则造成了障碍。
患者和护理人员重视以整体、关系为中心的护理，这种护理在提供实际支持的同时给予情感安全感。然而，服务的不一致性、晚期过渡到姑息治疗以及系统性不平等限制了可及性。研究结果强调需要早期介入、综合服务模式以及全天候专业护理，以确保在家中临终护理方面有更大的连续性和公平性。
