This study aims to understand and improve community-based palliative care outside of normal working hours by providing essential evidence for health policy decision-makers to make informed decisions on service provision. 

Phase 1: To systematically review the evidence for models of out-of-hours care for patients with serious health-related suffering in the last year of life in the community and their families.

Phase 2: To characterise existing UK out-of-hours community-based specialist palliative care models and generate a typology of models.

Phase 3: To explore and contrast patients’ and families’ experiences of different models of out-of-hours community-based palliative care, and elucidate drivers of service utilisation (ED attendances and unplanned admissions) and preferred place of care.

This is a sequential, three-phase, mixed-methods study.

Phase 1: We will systematically examine published evidence on different ways of providing community palliative care.

Phase 2: We will develop a standard way to describe the different models of care currently available, talking with patients, family, carers and staff members to identify the most important components for good quality out-of-hours care. We will compare and contrast sites’ models of care using the standard criteria we have developed and from this, we will identify differing out-of-hours models of care.

Phase 3: We will interview patients and family caregivers about their experiences of care outside normal working hours from three services identified in phase 2. We will ask patients and families about any unmet needs outside of working hours and will consider how the different models of care affect the patients' and family caregivers' experience and their ability to remain in their preferred place of care.