A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Abstract

AbstractBackgroundPeople with palliative and end-of-life care needs in the community and their carers often rely on out-of-hours services to remain at home. Policymakers internationally have recommended implementation of telephone advice lines to ensure 24-hour access to support. However, little is known about their effectiveness.AimTo review the evidence for the clinical and cost effectiveness of out-of-hours-telephone advice lines for adults with palliative care needs living at home and their carers, and report service characteristics associated with effectiveness.DesignRapid systematic review, with narrative synthesis (PROSPERO ID: CRD42023400370).Data sourcesThree databases (Medline, EMBASE, CINAHL) were searched in February 2023 for studies reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsTwenty-one studies, published 2000-2022, were included. Most studies were observational; none were experimental. Three were comparative, and seven lacked explicit research questions or methods. Results were largely descriptive, focusing on service development and use, and process measures. Patient and carer outcomes were primarily reported qualitatively. Only two studies investigated possible system outcomes, by examining care-seeking behaviour after using telephone advice lines.ConclusionExisting evidence for the effectiveness of telephone advice lines is limited. The lack of experimental studies evaluating individual or system-level outcomes prevents assessment of the effectiveness/cost-effectiveness of service models. There is a clear need for more rigorous evaluations using consistent reporting, and inclusion of patient and carer perspectives during both development and implementation. Recommendations for future evaluations are provided.Key statementsWhat is already known about the topic?- Urgent and unplanned emergency department and hospital admission is frequent for people in the final months of life.- Designated palliative care telephone advice lines have been recommended internationally to ensure round-the-clock access to support from trained professionals and are proposed to help reduce urgent and unplanned use of acute services.- While a range of palliative care telephone advice lines exist, the evidence base for their effectiveness, in terms of patient and service use outcomes, is not known.What this paper adds- This review provides an overview of published articles reporting palliative care telephone advice line models that have been developed and implemented.- We demonstrate that existing research evidence for the effectiveness of telephone advice lines is limited and largely based on observational studies of insufficient methodological quality.- Our synthesis of findings suggests telephone advice lines can offer guidance and reassurance that supports family carers in providing care at home for patients who prefer to die at home.Implications for practice, theory or policy- Future development and evaluation of telephone advice lines need to include patients, carers, and other stakeholders to better understand what needs and preferences should shape the services.- To address the limited and variable evidence identified, we provide recommendations for key components of structure and use of telephone advice line models that should be included in future research.