# Communication during out-of-hours primary care contacts for people with a terminal illness: a scoping review

## TL;DR

This review explores how communication happens during out-of-hours primary care for people with terminal illnesses and identifies barriers and facilitators to effective communication.

## Contribution

The study is the first scoping review to focus specifically on end-of-life communication in out-of-hours primary care settings.

## Key findings

- Barriers to communication include lack of continuity of care and challenges with remote consultations.
- Facilitators include access to patient information and empathetic approaches by healthcare professionals.
- Limited research exists on end-of-life communication in this context, highlighting a need for further studies.

## Abstract

To summarise what is known about communication during out-of-hours primary care contacts for people with a terminal illness.

A scoping review following the Joanna Briggs Institute guidance for scoping reviews and conducted in accordance with Arksey & O’Malley’s methodological framework for scoping reviews.

Searches of MEDLINE, PsycINFO, CINAHL and EMBASE were conducted from inception to 23 July 2024, alongside grey literature searches and hand searching reference lists of relevant reviews.

Sources were eligible if they provided evidence about communication between people with a terminal condition, their families and/or healthcare professionals during contacts with out-of-hours primary care services.

Data were extracted by two independent researchers following Joanna Briggs Institute guidelines for scoping reviews. Findings were thematically synthesised to create a narrative account of the evidence.

Of the 1745 records identified, 18 studies were included in the review. Most used qualitative interviews and/or focus groups. Barriers to good communication included a lack of continuity of care, problems relating to remote consultations, the delegitimising of help seeking, and the challenges of conducting specialist palliative care consultations within a generalist out-of-hours system. Facilitators to good communication included the availability of information about patients and families out of hours, an empathetic and confident approach from out-of-hours professionals, and support from colleagues.

The scoping review showed that there is limited research focusing specifically on end-of-life communication in out-of-hours primary care settings. Further research is needed, particularly using observations or recordings of real interactions. There are several challenges to communication in this setting, but providing clinicians with access to palliative care summaries, alongside training and support in this specialised communication, can facilitate good end-of-life communication with patients and their families.