• Catherine Walshe, Céu Mateus, Sandra Varey, Steven Dodd, Zoe Cockshott, Luís Filipe, and Sarah G Brearley.
• International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, England, UK.
• Palliat Med. 2023 Dec 1; 37 (10): 148414971484-1497.

BackgroundHealthcare usage patterns change for people with life limiting illness as death approaches, with increasing use of out-of-hours services. How best to provide care out of hours is unclear.AimTo evaluate the effectiveness and effect of enhancements to 7-day specialist palliative care services, and to explore a range of perspectives on these enhanced services.DesignAn exploratory longitudinal mixed-methods convergent design. This incorporated a quasi-experimental uncontrolled pre-post study using routine data, followed by semi-structured interviews with patients, family carers and health care professionals.Setting/ParticipantsData were collected within specialist palliative care services across two UK localities between 2018 and 2020. Routine data from 5601 unique individuals were analysed, with post-intervention interview data from patients (n = 19), family carers (n = 23) and health care professionals (n = 33; n = 33 time 1, n = 20 time 2).ResultsThe mean age of people receiving care was 73 years, predominantly white (90%) and with cancer (42%). There were trends for those in the intervention (enhanced care) period to stay in hospital 0.16 days fewer, but be hospitalised 2.67 more times. Females stayed almost 3.5 more days in the hospital, but were admitted 2.48 fewer times. People with cancer had shorter hospitalisations (4 days fewer), and had two fewer admission episodes. Themes from the qualitative data included responsiveness (of the service); reassurance; relationships; reciprocity (between patients, family carers and staff) and retention (of service staff).ConclusionsEnhanced seven-day services provide high quality integrated palliative care, with positive experiences for patients, carers and staff.

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