An out-of-hours protocol for community palliative care: practitioners’ perspectives

Abstract

Much of palliative care takes place in the patient's home. Out-of-hours service provision can be an area of concern. With the aim of improving this service, the former Calderdale and Kirklees Health Authority introduced an out-of-hours protocol for palliative care in the community. After 1 year the authors examined the experiences of primary care practitioners in using the protocol. Twenty district nurses and 15 GPs from 25 general practices in Calderdale, Huddersfield and North Kirklees took part in the study, which involved face-to-face group and individual telephone interviews. Practitioners felt that the out-of-hours protocol had made a positive contribution to palliative care in the community and that the out-of-hours handover form played a key role in improving communications and the coordination of services. For many participants, the protocol encouraged a more anticipatory approach to care and enabled better access to drugs and to specialist advice. The main areas of concern related to updating patient information on the handover forms, and to shortcomings in the support offered to carers. Future developments should address these issues. Although recognizing the dangers of generalization from research of this type, the findings offer encouragement to others considering similar schemes.

Supporting Patients and Their Caregivers After-Hours at the End of Life: The Role of Telephone Support

“…This knowledge needs to be used to facilitate appropriate staffing arrangements for afterhours palliative care services (15,29) . Our findings resonate with other researchers who have found that carers' feelings of uncertainty and anxiety are attenuated afterhours (37) . and that providers need to develop and identify process issues in care models (37,38) .…”

“…Our findings resonate with other researchers who have found that carers' feelings of uncertainty and anxiety are attenuated afterhours (37) . and that providers need to develop and identify process issues in care models (37,38) . Further, there is a need to further develop strategies to promote cross sector communication, particularly between primary and specialist palliative care…”

Organizational Interventions concerning Palliation in Community Palliative Care Services: A Literature Study

“…Two previous studies—from the UK and Australia—[20, 21] were concerned with the development and evaluation of a single information sheet, which intended to improve access to clinical information for nurses and doctors providing after-hours community palliative care services and an evaluation of GPs using an out-of-hours protocol. Both development initiatives were evaluated positively.…”

“…At the start of that period, there was a particular focus on cooperative models between the basis and specialised levels of palliation, trials of diagrams attempting to improve multidisciplinary cooperation and communication regarding families (e.g., [20, 21]), and trials of special intervention at discharge (72 hr special palliative service) [17], and so forth. In later years (e.g., [18, 30]), the focus has been on description, implementation, and evaluation of various guidelines, most recently on The Gold Standards Framework that specifically addresses palliative care in primary health care.…”

Ecological Theory in Practice: Illustrations From a Community-Based Intervention to Promote the Health of Recent Mothers

“…Template analysis is a form of qualitative analysis. It involves the development of a "purpose built" coding template or an a priori theme set which is then applied to a data set (King, 1998;King et al, 2003). Template analysis is less structured than content analysis, where researchers look for, code, and count particular instances of a topic or theme in a data set (King, 1998).…”