Health care assistants in out of hours community palliative care: multiple qualitative organisational case studies

Globally, the role, title and preparation of the unregulated worker is unstandardized, yet increasing evidence suggests they play an important role in the provision of palliative care. In the United Kingdom, a Health Care Assistant (HCA) is an unregulated healthcare worker who provides support to patients under the supervision of registered professionals across clinical settings. Whilst the provision of hospice out-of-hours (OOH) community palliative care is considered a key priority internationally; little is known about the role and contribution of the HCA in the provision of such care. This study aimed to understand the HCA’s role, responsibilities, and contribution to out-of-hours community palliative care. An organisational qualitative case study approach was adopted, studying six out-of-hours palliative care service models across the UK. Data collection used interviews from multiple perspectives (carers, managers, specialist nurses, and HCAs). In total, 59 semi-structured interviews were held between 2021 and 2022. Framework analysis was adopted to analyse the interviews. Two overarching themes were identified, relating to service and role complexity and impact of the HCA within OOH community palliative care. Both illustrate the variable environment of OOH community palliative care within which the role of the Health Care Assistants operates. Health Care Assistants were found to provide care for the dying patient and psychosocial support for wider family members. They were often the first to detect changes in patient conditions and played a key role, with recognising, responding and escalating care. Participants believed this helped to contribute to patients remaining in the home environment. Understanding both the nature of out of hours palliative care delivery and the work delivered by Health Care Assistants, is key to developing organisational structures that support patient care. Further studies to better understand how modification of these factors can be used to enhance care delivery and the effectiveness of the Health Care Assistants role in palliative care are warranted given the limited evidence base.