Evidence-based Palliative Care Research Articles

Advancing Evidence-based Palliative Care Research: Navigating Challenges and Proposing Solutions.

Amid the increasing demand for palliative care, driven by demographic shifts and medical progress, evidence-based practices face obstacles due to limited research. Complex patient conditions and ethical considerations challenge traditional methodologies, while the absence of comprehensive clinical trials hinders innovative interventions. Empowering practitioners with research skills and establishing a palliative care research network are efforts aimed at bridging these gaps. It is important to emphasise that these initiatives collectively aspire to enhance evidence-based practices, ensuring quality care for individuals facing severe illnesses.

VIRTUAL REALITY FOR PALLIATIVE CARE COMMUNICATION TRAINING: A NOVEL DISSEMINATION STRATEGY

Abstract Towards the end of life, 75% of older adults visit the emergency department (ED). During acute health decompensation, most older adults with serious illness (predicted survival of less than one year) do not have advance directives and are at risk of receiving care inconsistent with their goals. To deliver patient-centered care, palliative care communication skills are essential, especially during the shared decision-making for cardiopulmonary resuscitation (i.e., code status conversations). Facilitated by skilled faculty and trained actors playing the role of a seriously ill older adult in acute health decompensation, the traditional palliative care communication training combines role play and individual feedback to practice communication skills. These evidence-based, palliative care trainings have demonstrated to improve communication skills in trained clinicians with enduring skills 12-15 months later. However, these trainings take a minimum of four hours with highly trained faculty and professional actors to role play, which hinders wider dissemination. To improve nationwide dissemination of evidence-based practices in code status conversations, we have leveraged virtual reality technology to allow clinicians to experience in-person, palliative care communication training. In collaboration with a virtual reality company, a 360-degree view, virtual reality training content has been filmed in a real hospital environment. Using the same evidence-based, palliative care communication contents, clinicians in training can now experience the role play in a virtual reality environment in one hour instead of four. By leveraging virtual reality technology, evidence-based palliative care communication training can now be disseminated with much less institutional investment (e.g., training time, faculty resources, etc.).

Integrating palliative care and heart failure: a systematic realist synthesis (PalliatHeartSynthesis)

Objectives(1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the programme theory...

Enhancing palliative care at home: a generalist community nursing case study

Objective: This quality improvement project aimed to explore the experience of home care nurse managers implementing a general palliative approach to care. Implementation comprised several interlinking activities encompassing stakeholder engagement and an education program in the outer eastern region of a home care and nursing organisation in Melbourne, Australia, between September 2019 and December 2020. Background: High quality provision of community based palliative and end-of-life care means people are much more likely to die at home, supported by family, friends and services. To achieve this, care staff must be adequately trained and supported, alongside a collaborative approach with other generalist and specialist providers. Study design and methods: This Case Study reports on the participant perspectives of the stakeholder engagement and education program. Focus groups and an interview were used to elucidate the experience of nursing and allied health professionals providing a general palliative approach in the community. The 2006 National Institute of Clinical Studies framework to identify barriers to best practice healthcare guided the development of focus group questions and the deductive analysis of data. Results: Seven Nursing Care Managers and one Social Worker participated in two online focus groups and one interview. Three overarching themes highlighted the value of tailored education in increasing staff knowledge and confidence, the factors for a successful generalist-specialist partnership, and the unique nature of the home care setting which requires accessible systems and processes. Discussion: This project supports assertions that generalist services can play a valuable role when a palliative approach to care is incorporated. It also underscores the importance of collaborative working partnerships between generalist and specialist services in providing quality community-based palliative care. Future research should examine the needs and perspective of clients, carers and families receiving a general palliative care approach in the community. Implications for research, policy and practice: Investment in developing the capacity and capability of generalist service staff to deliver palliative care is vital, particularly when caring for people in their homes. Although small, this study demonstrates that consideration should be given to embedding staff with specialist palliative care training within generalist organisations to drive and champion evidence-based palliative care provision, training, policies and procedures that meet the unique needs of mobile workforces. Future research should examine the effectiveness of different models and methods for education and generalist-specialist partnerships that meet the needs of mobile home nurses, particularly regarding long-term impact and sustainability. What is already known about the topic? Most Australians prefer to be cared for and die in their own home. Home care nurses are key generalist health professionals who support community-based palliative and end-of-life care, organising and providing care, coordinating the input of other health and social care professionals. Home care nurses face challenges in meeting their clients’ palliative care needs (such as symptom management and communication) and have deficits in their knowledge and confidence of caring for palliative clients. What this paper adds: This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce.

A framework for integrating advanced practice palliative care competencies in nursing education

Introduction and objective: It is essential that nursing education prepares graduates to achieve the core skills required for the delivery of quality evidence-based palliative care. Hence, integrating advanced practice palliative care content into the nursing curriculum is an important priority. The objective of this study was to develop a framework and describe the process of integrating palliative care into the nursing curriculum to accelerate advanced practice palliative care competencies.Methods: Case-study methodology was used to describe an educational initiative. Through this initiative, palliative care education and skills-based resources have been integrated into the graduate nursing curriculum.Results: Varied palliative care learning resources have been incorporated and include sequential lectures, case studies, practice scenarios with identified palliative care needs, articles, and interprofessional palliative care simulations across multiple courses. To integrate palliative care content into the nursing curriculum a Framework for Integrating Palliative Care in Nursing Education was developed consisting of a cycle of five specific processes: 1) Assessment of curricular needs and goals, 2) Identification and development of resources, 3) Integration of teaching and learning activities, 4) Evaluation of content and learning, 5) Dissemination of resources and findings. A supportive organizational structure and an academic-practice partnership were identified as essential infrastructures for these processes.Conclusions: This educational initiative was vital in increasing the advanced practice nursing workforce with essential palliative care competencies to provide clinical leadership in a rapidly changing healthcare delivery system.

Australian residential aged care home staff experiences of implementing an intervention to improve palliative and end-of-life care for residents: A qualitative study.

Access to high-quality and safe evidence-based palliative care (PC) is important to ensure good end-of-life care for older people in residential aged care homes (RACHs). However, many barriers to providing PC in RACHs are frequently cited. The Quality End-of-Life Care (QEoLC) Project was a multicomponent intervention that included training, evidence-based tools and tele-mentoring, aiming to equip healthcare professionals and careworkers in RACHs with knowledge, skills and confidence in providing PC to residents. This study aims to understand: (1) the experiences of healthcare professionals, careworkers, care managers, planners/implementers who participated in the implementation of the QEoLC Project; and (2) the barriers and facilitators to the implementation. Staff from two RACHs in New South Wales, Australia were recruited between September to November 2021. Semi-structured interviews and thematic data analysis were used. Fifteen participants (seven health professionals [includes one nurse, two clinical educators, three workplace trainers, one clinical manager/nurse], three careworkers and five managers) were interviewed. Most RACH participants agreed that the QEoLC Project increased their awareness of PC and provided them with the skills/confidence to openly discuss death and dying. Participants perceived that the components of the QEoLC Project had the following benefits for residents: more appropriate use of medications, initiation of timely pain management and discussions with families regarding end-of-life care preferences. Key facilitators for implementation were the role of champions, the role of the steering committee, regular clinical meetings to discuss at-risk residents and mentoring. Implementation barriers included: high staff turnover, COVID-19 pandemic, time constraints, perceived absence of executive sponsorship, lack of practical support and systems-related barriers. The findings underline the need for strong leadership, supportive organisational culture and commitment to the implementation of processes for improving the quality of end-of-life care. Furthermore, the results highlight the need for codesigning the intervention with RACHs, provision of dedicated staff/resources to support implementation, and integration of project tools with existing systems for achieving effective implementation outcomes.

Inpatient palliative care use by patients with sickle cell disease: a retrospective cross-sectional study

ObjectiveSickle cell disease (SCD) is a highly morbid condition notable for recurrent hospitalisations due to vaso-occlusive crises and complications of end organ damage. Little is known about the use of...

Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR)

BackgroundThe importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care.MethodsThe Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation.ResultsFeatures of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07).ConclusionsA situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

Future palliative competence needs \u2013 a qualitative study of physicians\u2019 and registered nurses\u2019 views

BackgroundGlobally, the need for palliative care will increase as a result of the ageing of populations and the rising burden of cancer, non-communicable diseases as well as some communicable diseases. Physicians and registered nurses working in palliative care should have a sufficient level of education and competence in managing the changing needs and requirements of palliative care. There is, however, need for evidence-based palliative care training and education of physicians and registered nurses. The purpose of this study was to describe the views of physicians and registered nurses regarding future competence needs within palliative care.MethodsThe study was conducted through use of a cross-sectional qualitative design. A total of 54 physicians and 110 registered nurses completed an open-ended questionnaire about the future competence needs of palliative care. The data were analyzed using inductive content analysis.ResultsThe results revealed four main competence needs within palliative care for the coming decade: palliative care competence at all levels within healthcare and social welfare services; individualized palliative care competence; person-centered encounters competence; and systematic competence development within palliative care.ConclusionsThe results offer cues for education and professional development, which can be used to support physicians and registered nurses when future palliative care competences are included in educational programs. Seamless cooperation between palliative care services and educational institutions is recommended to ensure that undergraduate and postgraduate education is based on a continuous assessment of competence requirements within the field of palliative care. Therefore, online multi-professional simulations, for example, could be used to enhance future competencies within palliative care; undergraduate medical, nursing and allied healthcare students as well as postgraduate palliative care professionals and experts of experience could work together during simulations.

The developing evidence base for palliative care and neurological patients

Palliative care has been closely involved in the care of people with neurological disease for many years and is recommended within many guidelines. The palliative care needs of neurological patients are well described – physical, psychological and emotional, social and spiritual – together with the needs of caregivers. There has been increasing evidence, of variable quality, of the effectiveness of palliative care for people with life limiting disease, with evidence of reduced symptom burden, improved quality of life, reduced caregiver burden and increased ability of patients to be cared for at home.

Enhancing palliative care consultation workflow on an inpatient oncology unit.

208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.

Evaluating palliative care training in the oncology registrar programme in South Africa

Background. Following a World Health Assembly call in 2014 to strengthen palliative care, the South African (SA) Department of Health approved this strategy as part of the SA National Policy Framework and Strategy on Palliative Care. In 2016, the University of Cape Town, together with the College of Radiation Oncology of SA, identified the need to integrate palliative care (PC) into the oncology curriculum. In collaboration with the Cancer Association of SA, a research project was developed to introduce a 12-module curriculum at five teaching hospitals. The aim of this research was to evaluate the impact of a 1-year PC course within the training programme for specialist oncologists in SA. Objective. To determine the reaction of oncology registrars and their supervisors to the course to determine changes in knowledge and skills, and to determine the application in oncology practice. Methods. This study was a mixed-method prospective evaluation of an educational intervention. The educational programme used a blended learning method to train and support registrars ( n =32) and facilitators ( n =5) across five universities from August 2017 to September 2018. Evaluation feedback was electronically collected to determine the registrars’ reactions to the course materials. Pre and post multiple-choice questions (MCQs) were used to review their knowledge. Focus group discussions (FGDs) were used to explore reactions, change in knowledge and skills and how registrars integrated PC into their daily work. Results. There was an overwhelmingly positive reaction to the PC course by the oncology registrars and their supervisors. The training was found to be feasible, and the topics addressed appropriate. Concerns previously raised by the College of Radiation Oncology of SA regarding the feasibility and appropriateness of the course and material were found to be unsubstantiated. The poor MCQ results can be ascribed to poor sequencing of the execution of the question. However, the MCQs in modules 7 and 8 (symptom management) demonstrated the most significant change in knowledge and skills (symptom management). The FGDs demonstrated a perceived change in knowledge and skills, especially for communication skills and pain and symptom management. The FGDs also indicated that the registrars’ approach to PC changed in that they were able to integrate the principles of PC into practice, and now saw PC as an essential component of oncology. Lastly, registrars and their supervisors felt that the course addressed topics that formed part of their daily clinical work. Conclusion. This research supports the view that PC training is an essential component of oncology training in the SA setting. PC forms part of the daily practice of oncologists, and a structured curriculum prepares clinicians to be able to integrate evidence-based PC into the practice of oncology if they receive appropriate training. Supervisors of the oncology training programme and registrars are confident that the training of 12 modules across 1 year is feasible and appropriate.

Reimagining the inpatient palliative care consult: lessons from COVID-19

As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the past several months in epicenters of the COVID-19 pandemic, PC providers have responded to the increased need for PC services through innovative digital programs including telepalliative care programs. In this article, we explore how PC innovations during COVID-19 could transform the PC consult to address workforce shortages and expand access to PC services during and beyond the pandemic. We propose a 3-pronged strategy of bolstering inpatient telepalliative care services, expanding electronic consults, and increasing training and educational tools for providers to help meet the increased need for PC services in the future.

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

BackgroundThe demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals.MethodsA cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand.ResultsThe study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication.ConclusionThis model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

Top Ten Tips Palliative Clinicians Should Know About Evidence-Based Advocacy.

The escalating global burden of serious health-related suffering makes the need for funded policies that integrate palliative care (PC) into the continuum of services more urgent than ever. Palliative specialists are uniquely positioned to merge their clinical expertise with empirical evidence to advocate for improved PC delivery. There is a vital feedback loop between advocacy and clinical practice that palliative specialists can leverage to influence key stakeholders and decision makers and bridge PC policy deficits. Sustained interdisciplinary partnerships are critical to evidence-based PC advocacy that addresses resource gaps, social injustice, and unmet and disparate needs. Although PC advocacy may appear optional or even frivolous at times, it is an essential skill for any practitioner working to improve care for seriously ill individuals and their families. This article highlights 10 pragmatic tips that palliative specialists can use to advocate for policy changes that enhance PC access and equity at institutional, local, national, and global levels.

Definitions of Palliative Care Terms: A Consensus-Oriented Decision-Making Process.

Background: Lack of consistency in palliative care language can serve as barriers when designing, delivering, and accessing high-quality palliative care services. Objective: To develop a consensus-driven and evidence-based palliative care glossary for the Health Standards Organization Palliative Care Services National Standard of Canada (CAN/HSO 13001:2020). Design: Content analysis of the Palliative Care Services standard was used to refine a list of terms. Environmental scan and rapid review were used for identification of concepts and definitions. Two meetings of consultation based on the modified Delphi approach took place among a working committee consisting of 12 health care providers, administrators, academics, and patient/family representatives. Results: Palliative approach to care, quality of life, pain and symptom management, caregivers, palliative care, life-limiting illness, and serious illness were defined by modification/adoption of existing definitions. Conclusion: A glossary of key palliative care terms was developed and included in the HSO Palliative Care Services standard, which will facilitate communication using consistent language across care settings.

Translating Evidenced-Based Guidelines into Clinical Practice using Goal Setting and Palliative Program Dashboards (GP772)

• State sources of evidence-based palliative care guidelines• Describe methods of determining appropriate quality measures for individual practice• State potential outcomes/benefits of utilizing dashboards for guideline implementation. Palliative medicine practice is increasingly informed by evidence from clinical trials performed in academic medical centers. This evidence informs national practice guidelines, such as the National Consensus Project (NCP) and American Society of Clinical Oncology, aimed at improving quality of patient care. Translating these evidence-based guidelines into clinical practice is difficult due to resource limitations and lack of established models of palliative care delivery. This leads to gaps between published guidelines and clinical practice, particularly in the community setting. 1. State sources of palliative care guidelines 2. Describe methods of determining appropriate quality measures for individual practice 3. State potential outcomes/benefits of utilizing dashboards for guideline implementation Two palliative care programs, one academic and one community-based, translated guidelines into practice using interdisciplinary goal setting and creation of palliative care dashboards.The programs compared their practice to national guidelines to identify opportunities for improvement. Goals identified included implementation of opioid risk assessment, chemotherapy at end of life, 30-day readmissions, and frequency of palliative consultation for patients with advanced lung cancer. The outpatient Penn Medicine Lancaster General Health program, providing primarily Palliative Care in Oncology, used program dashboards to measure and encourage progress on identified goals, resulting in >50% improvement in measures such as palliative consultation for advanced cancers. Penn State Health Palliative Care implemented dashboard goals informed by NCP guidelines including psychosocial support and advance care planning completion. This led to >60% improvement in measured outcomes during the first year of implementation. Goal setting and creation of program dashboards can facilitate application of palliative guidelines.

A Pilot Cross-Discipline Evidence-Based Palliative Care Curriculum for Postgraduate Medical Trainees

IntroductionIt is widely recognized that physicians of all backgrounds benefit from having a general palliative care skill set to optimally manage their patients at the end of life. However, strategies to teach palliative care skills to trainees outside palliative medicine vary widely. In this report, we provide an evidence-based and cross-disciplinary palliative care framework applicable to a spectrum of specialty training environments and intended for nonpalliative care trainees. InnovationWe developed and implemented a concise, multimodal, and evidence-based pilot palliative care curriculum focused on essential general palliative care skills required by physicians providing patient care along the continuum of life across specializations. A needs assessment (local research, literature review, and consensus expert opinion) in combination with learner characteristics (Kolb Learning Style Inventory, Palliative Medicine Comfort and Confidence Survey, and knowledge pretest) informed the development of a curricular outline. The first iteration of the curriculum was formulated and delivered. Extensive evaluation, reassessment, and feedback led to a second iteration, which is presented here. OutcomesAlthough the context will differ according to specialization, there are essential palliative care skills required of most specialist physicians. General palliative themes identified for focus include symptom management, communication, psychosocial aspects of care, care coordination and access, and myths and pitfalls in palliative care. CommentSpecialty trainees' value embedded training in essential themes in palliative care within the context of their training program. The process and results of this project, including the provision of a framework, may be applied to postgraduate training programs in various specialties.

Clinical research in cancer palliative care: a metaresearch analysis

ObjectiveThis metaresearch of the clinicaltrials.gov database aims to evaluate how clinical research on palliative care is conducted within the setting of advanced cancer.MethodsClinicaltrials.gov was searched to identify registered studies recruiting...

Dignity-conserving care for persons with palliative care needs — identifying outcomes studied in research: An integrative review

With people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized. An integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis. Seven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of "Performance, symptoms and emotional concerns" and "End-of-life and existential aspects". Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as "Dignity-related distress" and "Quality of life" were common. However, the results lacked concrete communication outcomes. The results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.