Discontinuity of care at end of life: a qualitative exploration of OOH end of life care

Leydon, Geraldine M., Shergill, Narinder K., Campion-Smith, Charles, Austin, Helen, Eyles, Caroline, Baverstock, Jenny, Addington-Hall, Julia, Sloan, Richard and Moore, Michael V. (2013) Discontinuity of care at end of life: a qualitative exploration of OOH end of life care. BMJ Supportive & Palliative Care, 3 (4), 1-10. (doi:10.1136/bmjspcare-2012-000266).

Abstract

Objective This study aimed to understand the experiences of palliative care patients when accessing or making decisions about out of hours (OOH) services. It also aimed to illuminate barriers and enablers to accessing appropriate and timely care following the introduction of the 2004 New General Medical Services Contract.

Method Longitudinal prospective qualitative study using semi-structured interviews and telephone interviews over 6 months and analysed for thematic content. 32 patients defined as receiving palliative care in six General Practices and three hospices selected on the basis of size and rural/urban location in Southern England were recruited.

Results Continuity of care was highly valued. Participants described the importance of being known by the healthcare team, and the perceived positive implications continuity could have for the quality of care they received and the trust they had in their care. Various factors prevented participants from seeking help or advice from OOH services, despite having health concerns that may have benefitted from medical assistance. Prior poor experience, limited knowledge of services and knowing who to call and, indeed, when to call were all factors that reportedly shaped participants’ use of OOH services.

Conclusions Interpersonal or relationship continuity and management continuity are vital to the process of optimising the patient experience of OOH palliative care. While recent service innovations are tackling some of the issues highlighted, this research reinforces the value patients with palliative care needs places on continuity and the need to improve this aspect of care management.

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Contributors

Author: Geraldine M. Leydon

Author: Jenny Baverstock

Author: Michael V. Moore

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