Timely community palliative and end-of-life care : A realist synthesis
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
|Authors||Petrova, Mila, Wong, Geoff, Kuhn, Isla, Wellwood, Ian and Barclay, Stephen|
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.
|Keywords||end-of-life stage; palliative care; end-of-life care|
|Journal||BMJ Supportive and Palliative Care|
|Journal citation||pp. 1-15|
|Publisher||BMJ Publishing Group|
|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 access||Published as ‘gold’ (paid) open access|
|Research or scholarly||Research|
|Funder||National Institute for Health Research (NIHR)|
File Access Level
|Online||09 Dec 2021|
|Publication process dates|
|Accepted||19 Sep 2021|
|Deposited||10 Jan 2023|
|Grant ID||Project Number 390|
© 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/.
0views this month
0downloads this month