• Bruce Mason, Emma Carduff, Sheonad Laidlaw, Marilyn Kendall, Scott A Murray, Anne Finucane, Sebastien Moine, Joannes Kerssens, Andrew Stoddart, Sian Tucker, Erna Haraldsdottir, Sir Lewis Ritchie, Marie Fallon, Jeremy Keen, Stella Macpherson, Lorna Moussa, and Kirsty Boyd.
• Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK.
• Palliat Med. 2022 Mar 1; 36 (3): 478488478-488.

BackgroundUnscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs.AimTo document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours.DesignA mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners.SettingThree contrasting Scottish Health Board regions and national datasets for the whole of Scotland.ResultsPeople who died in Scotland in 2016 (n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified.ConclusionStrengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.

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