New publications to strengthen palliative care

The excellent research team has recently published two papers entitled 'Caregivers' Perspectives on Ethical Challenges and Patient Safety in Tele-Palliative Care: An Integrative Review' and 'Barriers for adult patients to access palliative care in hospitals: A mixed methods systematic review' to strengthen palliative care.

Nadine Schuessler and Manela Glarcher have published an article in the Journal of Hospice and Palliative Nursing entitled 'Caregivers' Perspectives on Ethical Challenges and Patient Safety in Tele-Palliative Care: An Integrative Review'. doi:10.1097/NJH.0000000000000986

The aim was to describe formal and informal caregivers' opportunities in tele-palliative care and the associated ethical and safety challenges using a Whittemore and Knafl integrative review method. Ethical and patient safety perspectives were extracted from studies reporting on tele-palliative care interventions. Content on ethically considerable information on the intervention was coded, categorized, and summarized into a matrix developed in advance from literature on socio-technical arrangements and eHealth applications. Nine studies from experimental and nonexperimental research were included. Four studies reported exclusively on the perspective of formal caregivers, 3 studies addressed the perspective of patients and informal caregivers, and 2 studies covered the perspectives of both. Studies of tele-palliative care interventions implicate effects on patient-caregiver relationships but also show that technology is not seen as a replacement of holistic palliative care. However, the authors do not address other relevant ethical issues (eg, sustainability) or consider aspects of patient safety. There is a need for further research to assess privacy, data security, and patient safety in tele-palliative care from the perspective of caregivers as telehealth becomes increasingly important.

The team around Stefan Pitzer, Patrick Kutschar, Piret Paal, Patrick Mülleder, Stefan Lorenzl, Paulina Wosko, Jürgen Osterbrink and Johannes Bükki has published a review in the Journal of Pain and Symptom Management. The publication is entitled 'Barriers for adult patients to access palliative care in hospitals: A mixed methods systematic review'. doi:10.1016/j.jpainsymman.2023.09.012.

The aim was to review the current evidence on barriers that impair, delay, or prohibit access to palliative care for adult hospital inpatients. A mixed methods systematic review was conducted using an integrated convergent approach and thematic synthesis (PROSPERO ID: CRD42021279477). The Cochrane Library, MEDLINE, CINAHL, and PsycINFO were searched from 10/2003 to 12/2020. Studies with evidence of barriers for inpatients to access existing palliative care services were eligible and reviewed. After an initial screening of 3,359 records and 555 full-texts, 79 studies were included. Thematic synthesis yielded 149 access-related phenomena in 6 main categories: (1) Sociodemographic characteristics, (2) Health-related characteristics, (3) Individual beliefs and attitudes, (4) Inter-individual cooperation and support, (5) Availability and allocation of resources, and (6) Palliative care-specific challenges. While evidence was inconclusive for most socio-demographic factors, the following barriers emerged: having a non-cancer condition or a low symptom burden, the focus on cure in hospitals, non-acceptance of terminal prognosis, negative perceptions of palliative care, misleading communication and conflicting care preferences, lack of resources, poor coordination, insufficient expertise, and clinicians' emotional discomfort and difficult prognostication. Hospital inpatients face multiple barriers to accessing palliative care. Strategies to address these barriers need to take into account their multidimensionality and long-standing persistence.