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Johansson T, Chambers RL, Curtis T, Pask S, Greenley S, Brittain M, Bone AE, Laidlaw L, Okamoto I, Barclay S, Higginson IJ, Murtagh FEM, Sleeman KE. The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review. Palliat Med 2024:2692163241248544. [PMID: 38708864 DOI: 10.1177/02692163241248544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND People with palliative care needs and their carers often rely on out-of-hours services to remain at home. Policymakers have recommended implementing telephone advice lines to ensure 24/7 access to support. However, the impact of these services on patient and carer outcomes, as well as the health care system, remains poorly understood. AIM To evaluate the clinical- and cost-effectiveness of out-of-hours palliative care telephone advice lines, and to identify service characteristics associated with effectiveness. DESIGN Rapid systematic review (PROSPERO ID: CRD42023400370) with narrative synthesis. DATA SOURCES Three databases (Medline, EMBASE and CINAHL) were searched in February 2023 for studies of any design reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool, and quantitative and qualitative data were synthesised narratively. RESULTS Twenty-one studies, published 2000-2022, were included. Most studies were observational, none were experimental. While some evidence suggested that telephone advice lines offer guidance and reassurance, supporting care at home and potentially reducing avoidable emergency care use in the last months of life, variability in reporting and poor methodological quality across studies limit our understanding of patient/carer and health care system outcomes. CONCLUSION Despite their increasing use, evidence for the clinical- and cost-effectiveness of palliative care telephone advice lines remains limited, primarily due to the lack of robust comparative studies. There is a need for more rigorous evaluations incorporating experimental or quasi-experimental methods and longer follow-up, and standardised reporting of telephone advice line models and outcomes, to guide policy and practice.
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Affiliation(s)
- Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Thomas Curtis
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Molly Brittain
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Lynn Laidlaw
- Cicely Saunders Institute Patient & Public Involvement Group, King's College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Fliss E M Murtagh
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
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Jácome M, Rego N, Veiga P. Potential of a nurse telephone triage line to direct elderly to appropriate health care settings. J Nurs Manag 2019; 27:1275-1284. [PMID: 31145491 DOI: 10.1111/jonm.12809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Abstract
AIM To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care. BACKGROUND Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. METHODS Cross-sectional descriptive analysis. RESULTS Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. CONCLUSIONS The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. IMPLICATIONS FOR NURSING MANAGEMENT Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.
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Affiliation(s)
- Marta Jácome
- Unidade de Saúde Familiar Bracara Augusta, Braga, Portugal
| | - Nazaré Rego
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,INESC TEC, Porto, Portugal
| | - Paula Veiga
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,GovJus, Universidade do Minho, Braga, Portugal
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Fradgley EA, Boltong A, O'Brien L, Boyes AW, Lane K, Beattie A, Clinton-McHarg T, Jacobsen PB, Doran C, Barker D, Roach D, Taylor J, Paul CL. Implementing Systematic Screening and Structured Care for Distressed Callers Using Cancer Council's Telephone Services: Protocol for a Randomized Stepped-Wedge Trial. JMIR Res Protoc 2019; 8:e12473. [PMID: 31099341 PMCID: PMC6542249 DOI: 10.2196/12473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/10/2019] [Accepted: 03/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Structured distress management, comprised a 2-stage screening and referral model, can direct supportive care resources toward individuals who are most likely to benefit. This structured approach has yet to be trialed in Australian community-based services such as Cancer Council New South Wales (NSW) and Victoria Cancer Information and Support (CIS) 13 11 20 lines who care for a large community of cancer patients and caregivers. Objective The aim of this study was to evaluate the effectiveness of structured screening and referral in (1) increasing the proportion of distressed CIS callers who accept supportive care referrals and (2) reducing distress levels at 6-month follow-up. Methods In this stepped-wedge trial, Cancer Council NSW and Victoria CIS consultants are randomized to deliver structured care during inbound 13 11 20 calls in accordance with 3 intervention periods. Eligible callers are patients or caregivers who score 4 or more on the Distress Thermometer; NSW or Victorian residents; aged 18 years or older; and English proficient. Study data are collected via computer-assisted telephone interviews (CATIs) at 3- and 6-month follow-up and CIS record audit. CATIs include demographic and service use items and the General Health Questionnaire (GHQ-28) to assess distress. An economic analysis of the structured care model will be completed. Results The structured care model was developed by guideline review and identification of service characteristics to guide mapping decisions; place-card methodology; and clinical vignettes with think-aloud methodology to confirm referral appropriateness. The model includes an additional screening tool (Patient Health Questionnaire-4) and a referral model with 16-20 CIS services. Descriptive statistics will be used to assess referral uptake rates. Differences between GHQ-28 scores for structured and usual care callers will be tested using a generalized linear mixed model with fixed effects for intervention and each time period. The trial will recruit 1512 callers. The sample size will provide the study with approximately 80% power to detect a difference of 0.3 SD in the mean score of the GHQ-28 at an alpha level of .05 and assuming an intra-cluster correlation of .04. A random sample of recorded calls will be reviewed to assess intervention fidelity and contamination. To date, 1835 distressed callers have been invited to participate with 60.71% (1114/1835) enrolled in the study. A total of 692 participants have completed 6-month CATIs. Recruitment is anticipated to end in late 2019. Conclusions This trial is among the first to rigorously test the outcomes of a community-based structured approach to distress management. The model is evidence-informed, practice-ready, and trialed in a real-world setting. The study outcomes will advance the understanding of distress management internationally for both patients and caregivers. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12617000352303; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372105&isReview=true (Archived by WebCite on http://www.webcitation.org/78AW0Ba09) International Registered Report Identifier (IRRID) DERR1-10.2196/12473
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Affiliation(s)
- Elizabeth A Fradgley
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Anna Boltong
- Strategy and Support, Cancer Council Victoria, Melbourne, Australia
| | | | - Allison W Boyes
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, Callaghan, Australia
| | - Katherine Lane
- Cancer Information and Support Services, Cancer Council Victoria, Melbourne, Australia
| | - Annette Beattie
- Cancer Information and Support Services, Cancer Council NSW, Woolloomooloo, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Psychology, University of Newcastle, Callaghan, Australia
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Christopher Doran
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, University of Central Queensland, Brisbane, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Della Roach
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jo Taylor
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Christine L Paul
- Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Doki S, Kaneko H, Oi Y, Usami K, Sasahara S, Matsuzaki I. Risk Factors for Suicidal Ideation Among Telephone Crisis Hotline Callers in Japan. Crisis 2016; 37:438-444. [PMID: 27245813 DOI: 10.1027/0227-5910/a000384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Telephone hotlines are a widely used type of suicide prevention program. AIMS The aim of this study was to clarify the risk factors for suicidal ideation by investigating its association with a number of characteristics among telephone hotline callers. METHOD Data were collected over a 10-year period from a total of 246,595 calls to Inochi No Denwa, a telephone crisis hotline in Ibaraki, Japan, and subsequently analyzed. Odds ratios for suicidal compared with nonsuicidal ideation were also calculated. RESULTS About 6% of the calls to the hotline were suicide related, and about 2% of the callers had attempted suicide in the past. Odds ratios for suicidal ideation increased during winter, but no daily tendencies were evident. Those whose problems were related to their way of life were at the highest risk of suicidal ideation, followed by those with health-related concerns. CONCLUSION We were able to identify risk factors for suicidal ideation based on an analysis of enormous amounts of data from a telephone crisis hotline in Japan. Knowledge of these risk factors is expected to lead to improvements in suicide prevention programs.
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Affiliation(s)
- Shotaro Doki
- 1 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.,2 Hospital Bando, Ibaraki, Japan
| | - Hidetoshi Kaneko
- 1 Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.,3 Soubu Hospital, Chiba, Japan
| | - Yuichi Oi
- 4 Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuya Usami
- 4 Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Ichiyo Matsuzaki
- 4 Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.,5 International Institute for Integrative Sleep Medicine, University of Tsukuba, Ibaraki, Japan
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Locatelli SM, LaVela SL, Talbot ME, Davies ML. How do patients respond when confronted with telephone access barriers to care? Health Expect 2014; 18:2154-63. [PMID: 24612441 DOI: 10.1111/hex.12184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To gain an in-depth understanding of patient barriers to accessing telephone care, subsequent responses to telephone access issues and recommendations for system improvement within a large integrated health-care system. STUDY DESIGN Cross-sectional qualitative focus group study. METHODS One focus group was conducted at each of 17 Veterans Affairs facilities with a total of 123 Veteran users of VA health care. All facilities followed a focus group discussion guide, and purposively sampled patients receiving care at their VA facility in primary and/or specialty care. Focus groups' recordings were sent to the authors' independent evaluation centre, transcribed verbatim and analysed using qualitative content analysis methodology. RESULTS Participants described many issues with the phone system that resulted in delays to care needs being addressed, including difficulty getting someone to answer the phone, out-dated phone directories, frequent disconnections and incorrect transfers. Participants most frequently responded to access issues by doing nothing or waiting to contact at a later time, or seeking unscheduled in-person care in the emergency department or primary care clinic. Participants offered recommendations for improving telephone care, including access to direct extensions, and upgrades to the telephone system. CONCLUSIONS Telephone access issues could result in increased patient harm and/or increased wait times for in-person primary care or emergency services. Periodic evaluation of telephone systems is necessary to ensure telephone systems adequately meet patient needs while using resources efficiently to optimize the delivery of high quality, safe health care.
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Affiliation(s)
- Sara M Locatelli
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary E Talbot
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Michael L Davies
- Office of Systems Redesign, Veterans Affairs Central Office, Washington, DC, USA
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Cooper D, Arnold E, Smith G, Hollyoak V, Chinemana F, Baker M, O'Brien S. The effect of deprivation, age and sex on NHS Direct call rates. Br J Gen Pract 2005; 55:287-91. [PMID: 15826436 PMCID: PMC1463131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The use of primary care services in the UK is traditionally high in deprived areas. There has been little research into the effect of deprivation on the uptake of NHS Direct, a national nurse-led health helpline. AIM To explore the impact of deprivation, age and sex on call rates to two NHS Direct sites. DESIGN OF STUDY Ecological study. SETTING West Yorkshire and West Midlands NHS Direct sites. METHOD Details of NHS Direct calls between July 2001 and January 2002 were linked to electoral wards and the Indices of Multiple Deprivation for 2000. Age-standardised call rates were calculated for five deprivation levels. Using a negative binomial regression model, West Yorkshire call rates were analysed by age group, sex, deprivation level and geographical location. Rates were mapped by ward for West Yorkshire NHS Direct. RESULTS Six-monthly call rates were highest for children under 5 years of age (130 per 1000 population). The ratio of female to male calls (all ages) was 1.30 (95% confidence interval [CI] = 1.27 to 1.33), this ratio being highest for the 15-44 year age group (P < 0.001). For both West Yorkshire and West Midlands NHS Direct, call rates (all ages combined) were highest in areas within the middle of the range of deprivation. West Yorkshire call rates about those under 5 years of age were lower in the most deprived areas than in the least deprived areas (< 1 year, P = 0.06; 1-4 years, P = 0.03). For adults aged 15-64 years, call rates were significantly higher in the most deprived areas (P < 0.001). CONCLUSION This work supports previous research and shows that overall demand for NHS Direct is highest in areas where deprivation is at or just above the national average. Additionally, this study suggests that the effect of extreme deprivation appears to raise adult call rates but reduce rates of calls about children.
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Affiliation(s)
- Duncan Cooper
- Regional Serveillance Unit, Centre for Infections, Health Protection Agency West Midlands, Birmingham.
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