A rapid systematic review of the effectiveness of out-of-hours palliative care telephone advice lines for people living at home and their carers

Background People with palliative and end-of-life care needs in the community and their carers often rely on out-of-hours services to remain at home. Policymakers internationally have recommended implementation of telephone advice lines to ensure 24-hour access to support. However, little is known about their effectiveness. Aim To review the evidence for the clinical and cost effectiveness of out-of-hours-telephone advice lines for adults with palliative care needs living at home and their carers, and report service characteristics associated with effectiveness. Design Rapid systematic review, with narrative synthesis (PROSPERO ID: CRD42023400370). Data sources Three databases (Medline, EMBASE, CINAHL) were searched in February 2023 for studies reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool. Results Twenty-one studies, published 2000-2022, were included. Most studies were observational; none were experimental. Three were comparative, and seven lacked explicit research questions or methods. Results were largely descriptive, focusing on service development and use, and process measures. Patient and carer outcomes were primarily reported qualitatively. Only two studies investigated possible system outcomes, by examining care-seeking behaviour after using telephone advice lines. Conclusion Existing evidence for the effectiveness of telephone advice lines is limited. The lack of experimental studies evaluating individual or system-level outcomes prevents assessment of the effectiveness/cost-effectiveness of service models. There is a clear need for more rigorous evaluations using consistent reporting, and inclusion of patient and carer perspectives during both development and implementation. Recommendations for future evaluations are provided. What is already known about the topic? What this paper adds Implications for practice, theory or policy ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was conducted as part of the Better End of Life Programme which is funded by Marie Curie (grant MCSON-20-102) and carried out by Kings College London in collaboration with Hull York Medical School, University of Hull, and University of Cambridge. K.E.S. is the Laing Galazka Chair in palliative care at Kings College London, funded by an endowment from Cicely Saunders International and the Kirby Laing Foundation. I.H. is an NIHR Senior Investigator Emeritus. F.E.M.M. is a National Institute for Health Research (NIHR) Senior Investigator. I.H. and S.B. are supported by the NIHR Applied Research Collaboration (ARC) South London (SL) and NIHR ARC East of England, respectively. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes