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An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review
journal contributionposted on 2023-07-28, 05:28 authored by Farwa Rizvi, HE Wilding, NM Rankin, R Le Gautier, L Gurren, V Sundararajan, K Bellingham, J Chua, GB Crawford, AK Nowak, B Le, G Mitchell, SA McLachlan, TV Sousa, R Hudson, M IJzerman, A Collins, J Philip
Background: Despite global support, there remain gaps in the integration of early palliative care into cancer care. The methods of implementation whereby evidence of benefits of palliative care is translated into practice deserve attention. Aim: To identify implementation frameworks utilised in integrated palliative care in hospital-based oncology services and to describe the associated enablers and barriers to service integration. Design: Systematic review with a narrative synthesis including qualitative, mixed methods, pre-post and quasi experimental designs following the guidance by the Centre for Reviews and Dissemination (PROSPERO registration CRD42021252092). Data sources: Six databases searched in 2021: EMBASE, EMCARE, APA PsycINFO, CINAHL, Cochrane Library and Ovid MEDLINE searched in 2023. Included were qualitative or quantitative studies, in English language, involving adults >18 years, and implementing hospital-based palliative care into cancer care. Critical appraisal tools were used to assess the quality and rigour. Results: Seven of the 16 studies explicitly cited the use of frameworks including those based on RE-AIM, Medical Research Council evaluation of complex interventions and WHO constructs of health service evaluation. Enablers included an existing supportive culture, clear introduction to the programme across services, adequate funding, human resources and identification of advocates. Barriers included a lack of communication with the patients, caregivers, physicians and palliative care team about programme goals, stigma around the term ‘palliative’, a lack of robust training, or awareness of guidelines and undefined staff roles. Conclusions: Implementation science frameworks provide a method to underpin programme development and evaluation as palliative care is integrated within the oncology setting.
Palliative carecancer care facilitiesevidence gapsimplementation sciencequality of lifesystematic review4203 Health Services and Systems4205 Nursing42 Health SciencesCancerClinical ResearchBehavioral and Social Science8.1 Organisation and delivery of services8 Health and social care services research7.2 End of life care7 Management of diseases and conditionsGeneric health relevance3 Good Health and Well Being4203 Health services and systemsPublic Health and Health Services not elsewhere classifiedMedical and Health Sciences not elsewhere classified