Protocol for a mixed methods exploratory investigation into the role and contribution of the healthcare assistant in out-of-hours palliative care

Felicity Hasson,Paul Slater,Tracey Mcconnell,Sonja Mcilfatrick,Anne Fee,Sheila Payne,Dori-Anne Finlay

doi:10.1186/s12912-021-00570-x

Abstract

BackgroundMost people spend their last year of life at home, with many wishing to die there, but patients may need access to care after hours. Out-of-hours palliative care is delivered by multi-disciplinary teams including Health Care Assistants (HCA). However, little is known about the role, contribution and impact Health Care Assistants have on out-of-hours palliative care services. The aim of this study is to examine the Health Care Assistant role, contribution and impact on service delivery and patient care in out-of-hours community palliative care provided by hospice organisations.Methods and analysisA mixed methods exploratory study consisting of four phases. Phase one involves a scoping review to systematically map and identify gaps in policy and literature on the HCA role in out-of-hours palliative care. In phase two, all United Kingdom hospices will be invited to participate in an online census to enable the development of a typology of out-of-hours services and the contribution of the Health Care Assistant. During phase three organisational case studies representing different service types will collect information from Health Care Assistants, patients, caregivers and service managers to gather qualitative and quantitative data about out-of-hours service provision and the Health Care Assistant role. Finally, phase four will synthesize and refine results through online focus groups.Ethics and disseminationEthical approval has been obtained for phase two through Ulster University Research Governance Filter Committee, Nursing and Health Research. Findings will be disseminated through practitioner and/or research journals, conferences, and social media.

Highlights

Most people spend their last year of life at home, with many wishing to die there, but patients may need access to care after hours
For each out-of-hours service typology, we will develop an in-depth organisational case study to create an understanding of the service, the professionals involved and the role the Health Care Assistant plays
Limitations include the single point in time data collection, with data only drawn based on United Kingdom out-of-hours community service models

Summary

Methods and analysis

Mixed methods design incorporating both qualitative and quantitative methods will be used as it provides a useful approach when studying real life, contextual situations [27]. These will be followed up with a purposive sample of HCA (n = 1–3) and key members of the OOH multidisciplinary team (n = 3–5) such as the GP, District Nurse, Specialist Palliative Care Nurse and/or other members of multidisciplinary team as required (e.g., social work), and will be selected from each hospice site (see criteria below). Participants will be initially recruited from key workers and stakeholders (n = 8–10) who took part in phase three (case studies) and identified as knowledgeable informants about HCA role and OOH community palliative care (i.e. HCAs, senior managers and other health care professionals). Public Dissemination of findings aimed at the public will be facilitated through links with organisations including Marie Curie, National Council of Palliative care and Dying Matters

Strengths and limitations of this study

Background

Findings