Timely community palliative and end-of-life care : A realist synthesis

Journal article


Petrova, Mila, Wong, Geoff, Kuhn, Isla, Wellwood, Ian and Barclay, Stephen. (2021). Timely community palliative and end-of-life care : A realist synthesis. BMJ Supportive and Palliative Care. pp. 1-15. https://doi.org/10.1136/bmjspcare-2021-003066
AuthorsPetrova, Mila, Wong, Geoff, Kuhn, Isla, Wellwood, Ian and Barclay, Stephen
Abstract

Background Community-based and home-based palliative and end-of-life care (PEoLC) services, often underpinned by primary care provision, are becoming increasingly popular. One of the key challenges associated with them is their timely initiation. The latter requires an accurate enough prediction of how close to death a patient is.

Methods Using ‘realist synthesis’ tools, this review sought to develop explanations of how primary care and community PEoLC programmes generate their outcomes, with the explanations presented as context–mechanism–outcome configurations. Medline, Embase, CINAHL, PsycINFO, Web of Science, ASSIA, Sociological Abstracts and SCIE Social Care Online were originally searched. A multistage process of focusing the review was employed, with timely identification of the EoL stage and timely initiation of associated services representing the final review focus. Synthesised sources included 21 full-text documents and 324 coded abstracts, with 253 ‘core contents’ abstracts generating >800 codes.

Results Numerous PEoLC policies and programmes are embedded in a framework of Preparation and Planning for Death and Dying, with identification of the dying stage setting in motion key systems and services. This is challenged by: (1) accumulated evidence demonstrating low accuracy of prognostic judgements; (2) many individuals’ orientation towards Living and Hope; (3) expanding grey zones between palliative and curative care; (4) the complexity of referral decisions; (5) the loss of pertinent information in hierarchical relationships and (6) the ambiguous value of having ‘more time’.

Conclusion Prioritising temporal criteria in initiating PEoLC services is not sufficiently supported by current evidence and can have significant unintended consequences.

PROSPERO registration number CRD42018097218.

Keywordsend-of-life stage; palliative care; end-of-life care
Year2021
JournalBMJ Supportive and Palliative Care
Journal citationpp. 1-15
PublisherBMJ Publishing Group
ISSN2045-435X
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjspcare-2021-003066
Web address (URL)https://spcare.bmj.com/content/early/2022/04/25/bmjspcare-2021-003066
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-15
FunderNational Institute for Health Research (NIHR)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online09 Dec 2021
Publication process dates
Accepted19 Sep 2021
Deposited10 Jan 2023
Grant IDProject Number 390
Additional information

© Author(s) (or their employer(s)) 2021. Re- use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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