Out of hours palliative care in a rural area in the Midlands, England: a qualitative study of carers, caring for family members at the end of life and professionals

Introduction Demand for community-based palliative care has increased alongside prevalences of multi-morbidities, long-term life limiting illnesses, and an ageing population. Evidence suggests most people would like to die at home, and policies and frameworks in England have focused on the development of local services and supporting the provision of end-of-life care at home. Nevertheless, provision of out-of-hours palliative services remains patchy, which is exacerbated by the co-ordination of care services and inequity of care provision for patients in rural areas. However, a gap still exists to understand the effectiveness of these services and how they can be better utilised to support the population. Aim This study reviewed an out-of-hours nurse-led roaming car service, which was run and delivered by a hospice to support palliative care patients and their carers’. As part of this, the study identified what currently works when delivering the service and the challenges faced to provide the service. Method This was a qualitative retrospective study to collect data from both carers and health professionals who delivered the service. Carers were interviewed individually using semi-structured interviews and the health professionals were invited to join a focus group. All data was collected online via Skype and data were analysed thematically. Results From the focus group with health professionals, three themes identified were: challenges in communication; opportunities to improve service delivery and identifying what currently works; and service delivery and opportunities to work smarter. Interviews with carers did not reveal clear areas for service development but were useful to identify how contact began with the roaming car service, when intervention from the service was beneficial, and the support and reassurance the service provided. Conclusion The out-of-hours service provides an important contribution to the care and support for patients and their carers’ in rural areas during the end-of-life phase. There is a clear commitment from the service to meet both policy and the needs of patients and their carers’ as part of the delivery of a high level of care. Key challenges for service delivery were also identified to continue to address patient needs in rural areas.