Box 2.

Circumstances leading to out-of-hours hospital admissions for patients receiving end-of-life care

Thematic area	Themes	Subthemes
Participants	Patients	Patient needs or wishes
	Caregivers	Carer inexperience of death Carer preferences Carer burnout Carer uncertainty Carer breakdown
	Both	Patient or carer distress Patient or carer anxiety

Structures and processes	Policy	Lack of advance care planning Concerns about timely access to anticipatory medication
	Organisation	Unavailability or limited capacity of alternative services Lack of systems in place Lack of availability or accessibility of patient information Lack of flexibility (fixed structure) Complexities of workforce management Lack of continuity of care Lack of time to assess and address needs
	Provider	Lack of training Poor communication Inability to provide care Unfamiliarity with the patient Feeling of not performing their duties Fear of professional repercussions

Clinical factors	Assessment or diagnosis	Clinical or diagnostic uncertainty Complexity of the situation
	Symptom management	Treatment of pain or other physical symptoms Complication of treatment or failure of initial treatment
	Precaution or follow-up	As a precaution Abnormal laboratory results Further investigation