• Anne Fee, Deborah Muldrew, Paul Slater, Sheila Payne, Sonja McIlfatrick, Tracey McConnell, Dori-Anne Finlay, and Felicity Hasson.
• Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK.
• Palliat Med. 2020 Sep 1; 34 (8): 976-988.

BackgroundAccess to community palliative care 'out-of-hours' - defined as care provided after the normal hours of work - is advocated globally. Healthcare assistants, who provide care under the direction of a qualified professional, are increasingly employed to help deliver such care, yet there is a little understanding regarding their role, responsibilities or contribution.AimThe aim of this study was to identify the roles, responsibilities and contributions of healthcare assistants in out-of-hours community palliative care.DesignScoping review.Data SourcesFive bibliographic databases (CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus) and grey literature were searched using a predefined search strategy. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement.ResultsThe search yielded six papers using quantitative, qualitative and mixed methods. Results highlighted a lack of recognition of the role and contribution of healthcare assistants. A concurrent theme was that healthcare assistants continually monitored and responded to patient's and family's physical and emotional needs; there was also self-reported evidence indicating patient and family benefit, such as maintaining a sense of normality and support to remain at home.DiscussionThis review highlighted a dearth of evidence relating to the healthcare assistant role in out-of-hours palliative care. Limited evidence suggests they play a role, but that it is hidden and undervalued. Such invisibility will have a significant impact on the planning and delivery of out-of-hours palliative care. Future research is needed on role development for the benefit of patients and caregivers.

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