RT Journal Article
SR Electronic
T1 Out-of-hours services and end-of-life hospital admissions: A complex intervention systematic review and narrative synthesis
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP BJGP.2021.0194
DO 10.3399/BJGP.2021.0194
A1 Evie Papavasiliou
A1 Sarah E. Hoare
A1 Ben Bowers
A1 Michael P Kelly
A1 Stephen Barclay
YR 2021
UL http://bjgp.org/content/early/2021/06/25/BJGP.2021.0194.abstract
AB Background: Out-of-hours hospital admissions for end-of-life care patients are a common cause for concern to patients, families, clinicians and policy makers. It is unclear what issues, or combinations of issues, lead out-of-hours clinicians to initiate hospital care for these patients. Aim: To investigate the circumstances, processes and mechanisms of UK out-of-hours services-initiated end-of-life care hospital admissions. Design and Setting: Systematic literature review and narrative synthesis. Method: Eight electronic databases were searched from inception to December 2019 supplemented by hand-searching of BJGP. Key search terms included: out-of-hours services, hospital admissions and end-of-life care. Two reviewers independently screened and selected papers and undertook quality appraisal using Gough’s Weight of Evidence Framework. Data was analysed using narrative synthesis and reported following PRISMA Complex Intervention Guidance. Results: Searches identified 20,227 unique citations, 25 of which met the inclusion criteria. Few studies had a primary focus on the review questions. Admissions were instigated primarily to address clinical needs, caregiver and/or patient distress and discontinuity or unavailability of care provision and were arranged by a range of out-of-hours providers. Reported frequencies of end-of-life care patients being admitted to hospital varied greatly; most evidence related to cancer patients. Conclusion: While out-of-hours end-of-life care can often be readily resolved by hospital admissions, it comes with multiple challenges that seem to be widespread and systemic. Further research is therefore necessary to understand the complexities of out-of-hours services-initiated end-of-life care hospital admissions and how the challenges underpinning such admissions might best be addressed.