To investigate the access to specialist palliative care (SPC) and its impact on healthcare utilization at the end of life in patients with multiple myeloma (MM). This retrospective cohort study examined all Finnish patients who died of MM in 2019. Data were collected from national health databases. Patients were categorized by whether they had contact with SPC or not. We identified 278 patients (median age at death 77.5 years, 44.2% male), of whom 23.4% had SPC contact a median of 38 days before death. During the last 6 months of life, 92.4% of all patients had contact with the emergency department, 83.5% were hospitalized in secondary care, and 65.5% were hospitalized in primary care hospitals. Patients with SPC contact had fewer emergency department visits (50.8% vs. 65.3%, p = 0.041) and hospitalizations in secondary care (41.5% vs. 62.0%, p = 0.004) in the last month of life and fewer hospital deaths (69.2% vs. 84.0%, p = 0.012). Despite high healthcare service utilization at the end of life, access to SPC was often limited and late. Contact with SPC reduced acute healthcare utilization at the end of life, indicating better end-of-life care.

The benefits of initial palliative care (PC) consultation for patients with amyotrophic lateral sclerosis (ALS) have been previously described. The aim of this study was to explore the evolution of PC needs of patients with ALS over time through analysis of PC follow-up visits. Patients followed at a multidisciplinary ALS clinic received PC consultations and follow-ups between October 2020 and April 2022. All patients who received at least one PC follow-up visit were included in this study. Physician documentation of the visits was analyzed for sub-themes and topics. Topics discussed during visits and visit frequency were examined in the context of patient variables. The 26 patients had at least one PC follow-up visit (range 1-12 visits). Topics of discussion varied by individual rather than disease status and were often discussed repeatedly. Compared to initial consultations, follow-up visits featured more frequent discussion of sialorrhea and less frequent discussion of constipation, pain, and prognosis (all p < 0.05). Care coordination was discussed in 82% of follow-ups. Time between follow-up visits shortened as the disease progressed. Medical assistance in dying (MAID) was discussed by 31% of patients either at initial consultation or follow-up. Each individual with ALS has unique PC needs. PC specialist resource planning should anticipate higher frequency visits for patients later in the disease course. Given the importance of care coordination and the scarcity of PC specialists, we recommend further study of effective models of care coordination. We recommend that PC specialists be comfortable counseling patients on MAID.

Patients with advanced Parkinson's disease and related disorders (PDRD) experience significant symptom burden, yet access to specialist palliative care (SPC) is often limited. The Bristol service uses existing resources to form a multidisciplinary meeting (MDM) attended by both movement disorders and palliative care specialists. This integrates primary and SPC and allows sharing of expertise to holistically address unmet palliative care needs. Here, we evaluate this model. We conducted a retrospective review of case notes of patients discussed in the Parkinson's Disease Palliative Care MDM between February 2020 and April 2025. Of 106 patients (mean age 77.3 years), 87% were referred by the specialist movement disorders team. The primary reasons for referral included symptom control (74%) and emotional/psychological support (43%). Almost two-thirds (64%) were not previously known to hospice services. During follow-up, 66% of patients died, with a median time to death of 118 days (-10 to 1182). These occurred most commonly at home (43%) or in nursing homes (40%), with few hospital deaths (13%). An integrated palliative care service for those with PDRD is sustainable, improves access for groups otherwise unknown to SPC services and may facilitate preferred place of death and reduce hospitalisation at end of life. This requires further evaluation.

Palliative care improves the quality of life of people living with life-limiting conditions and their families; however, global access remains constrained by workforce shortages and late referrals. Artificial Intelligence (AI) has been proposed as a scalable solution for optimising the identification of needs, supporting clinical decision-making, and enhancing care delivery. However, real-world evidence of the application of AI in palliative care remains sparse, particularly regarding its impact on quality of life, quality of care, and associated practical, technical and ethical challenges. A scoping review was conducted following the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. Five databases (the ACM Digital Library, CINAHL, Cochrane Central, PubMed and Web of Science) were searched between September and October 2025. Studies reporting the use of AI to facilitate or enhance palliative care delivery in adults were eligible. Four reviewers independently screened the records, and two reviewers extracted the data using Covidence software. A narrative synthesis was then performed. Fifteen studies, published between 2021 and 2025, were included. Fourteen originated from Global North settings (USA 5, Germany 2, Japan 2, Taiwan 2, UK 1, Spain 1 and Cyprus 1) and one from Iran. Conceptually, AI applications fall into three domains: (1) early identification of palliative care needs, (2) symptom assessment and management and (3) clinical decision support for care conversations. Fifteen studies (100%) reported or discussed quality of care outcomes, most commonly prognostic performance, usability and referral/conversation rates, and only two (13.3%) directly addressed quality of life. Effectiveness was consistently positive, with four randomised controlled trials demonstrating superiority over usual care in referrals, advance care planning, pain control and quality of life domains. Practical barriers were centred on workflow integration and resource demands, while technical limitations include data quality, generalisability, and interpretability. Ethical discourse is underdeveloped, with major gaps in the principles of AI governance. AI shows potential to improve prognostic accuracy, trigger earlier involvement of palliative care specialists and support symptom management. However, this evidence is geographically skewed, methodologically immature and ethically underdeveloped. Future research must prioritise diverse global settings, patient-reported quality of life outcomes, participatory co-design and systematic ethical governance to ensure equitable implementation.

To investigate access to specialist palliative care (SPC) and healthcare service utilization at the end of life among patients with acute leukemia. This retrospective register study included all adult patients who died of acute leukemia in Finland in 2019. Data was collected from national databases. Patients were categorized based on whether they had contact with SPC or not. In total, 206 patients were included, of whom 25% had SPC contact median of 57 days before death. SPC contact was associated with fewer secondary care hospitalizations (42% vs. 73%, p < 0.001) and readmissions (12% vs.27%, p = 0.022) in the last 30 days of life and fewer hospital deaths (44% vs. 94%, p < 0.001). Patients with acute leukemia had low use of SPC services and high utilization of healthcare services at the end of life. Contact with SPC was associated with reduced secondary care hospitalizations, readmissions, and hospital deaths.

Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied. To compare total and daily hospital costs associated with early versus late initiation of sPC during the terminal hospital admission of patients who died in hospital. Retrospective cohort study using routinely collected administrative and clinical hospital data. Costs were analyzed using generalized linear models adjusted with inverse probability of treatment weighting. Bias-corrected mean ratios with 95% confidence interval (CI) calculated from 2,000 bootstrapped samples were presented. The study was conducted at a single Swiss tertiary care hospital and included adults aged ≥18 years who died during their terminal hospitalization between 2016 and 2022 and received sPC. Early sPC was defined as initiation within three days of admission. Patients with refusal of data use, external causes of death, perioperative death in otherwise healthy individuals, or incomplete cost data were excluded. The cohort comprised 790 patients (397 early sPC; 393 late sPC). Adjusted total hospital costs were substantially lower among patients receiving early sPC (CHF, 22,999; 95% CI: 21,149-25,072) compared with late sPC (CHF, 60,691; 95% CI: 55,186-67,165). Patients receiving early sPC also had lower daily costs. The largest cost differences occurred in pharmacy, laboratory, material, and room categories, whereas staff costs were similar between groups. Early initiation of sPC during terminal hospitalizations is associated with markedly lower hospital costs without increased staff expenditures. Additional studies are needed to establish whether this association is causal. Nonetheless, these findings suggest that providing patients with the benefits of sPC earlier during terminal hospitalization may be possible without increasing overall hospital costs and may have important implications for health care resource utilization.

Background The principle of double effect is often invoked to interpret clinical intentions in palliative sedation (PS), considering that intended effect may differ from foreseen effect. Despite clarifications, intentions concerning patient consciousness remain ambiguous. Moreover, little is known about how non-palliative care specialists understand and apply these intentions. Methods This study aims to explore physicians' intentions regarding PS, with a particular focus on the relationship between their intentions and patients' consciousness. This qualitative study is based on twelve semi-structured interviews with physicians from a university hospital in France. The methodology combined hierarchical evocation, clinical vignettes, and semi-structured interviews. Results The study reveals considerable heterogeneity in physicians' intentions regarding patient unconsciousness. The distinction between intended and foreseen effects was often poorly understood. References to the doctrine of double effect were rare, whereas the principle of proportionality was more frequently acknowledged. Conclusion This study reveals important discrepancies between specialized frameworks and the conceptual models of clinical reasoning. We particularly highlighted the inadequacy of the principle of double effect to enable an explicit evaluation of the ethical significance of induced unconsciousness and proposed a more integrated approach to palliative sedation, grounded in contemporary evidence, and proportionality.

IntroductionAvoidable and unfair variation in access to palliative care exists for different groups of people and communities. Primary and community care teams deliver most palliative care and care to people at the end of life at home but the quality of care provided is variable. This is an under-researched area and receives little attention in service design and policy. This study will investigate the key contexts, resources and components required for an integrated approach to palliative care to deliver improved and more equitable outcomes for patients and carers.Methods and analysisThis mixed-methods study adopts a realist methodological approach, and comprises four work packages:A multi-perspective mixed-methods study to understand patient preferences and priorities in palliative care, prioritising recruitment of patients and family members/carers from areas of socioeconomic deprivation. Data collection will comprise: (1) qualitative interviews, (2) review of patient case notes and (3) a discrete choice experiment. Realist analysis will result in the development of theory based on the identification of the key contexts and underlying mechanisms required to achieve beneficial outcomes through an integrated approach to palliative care.A realist evaluation of existing integrated models of palliative care will involve theory-refining interviews and theory-consolidating focus groups with professionals working in three different service areas.Dynamic simulation modelling of the healthcare resources needed to deliver the proposed integrated approach, ensuring quality and equity.The theoretical and economic modelling will be tested out at two expert stakeholder workshops to determine the key enablers to implementation in practice.Patient and public involvementThe study design was informed by patient and public involvement (PPI) with 16 patients and members of the public from diverse and socioeconomically deprived communities for 12 months in a National Institute for Health and Care Research-funded palliative care partnership. PPI will be continuous throughout the study, prioritising inclusivity.Ethics and disseminationEthical approval was obtained from the East of Scotland Research Ethics Service Research Ethics Committee 2, on 20 August 2025 (IRAS ID: 354755) and Health Research Authority approval on 1 October 2025. The targeted dissemination strategy will include outputs and resources for key audiences including patients and families, professionals in primary care and specialist palliative care and service commissioners. The results will inform service delivery to reduce inequities and optimise the use of finite resources to maximise impact.Trial registration detailsThe study is registered with the ISRCTN UK Clinical Study Registry: https://www.isrctn.com/ISRCTN61092011.

Background:While healthcare costs continue to grow, an aging population along with rising chronic diseases are increasing demand for high-quality end-of-life care.Objective:Our objectives include calculating hospital cost sub-categories, such as laboratory, medication, nursing, physician, and social counseling, and evaluating the economic impact of specialist palliative care (sPC) on overall hospital costs per stay and per day of severely ill and dying patients who died at a Swiss university hospital between 2016 and 2022.Design:Retrospective, observational cohort study with a control group.Methods:We used administrative cost data from the final hospitalization of patients who died at a university hospital in Switzerland. We compared hospital costs of patients receiving care, including sPC, with those of individuals receiving usual care (UC). We defined timely sPC referral as initiating within 3 days of admission. We used a generalized linear model—assuming gamma-distributed errors and with a logarithmic link function—adjusted by inverse probability weighting to adjust for patient characteristics differences.Results:Adjusted overall hospital costs per stay were higher for sPC (Swiss francs (CHF) 31,350 (95% confidence interval (CI) 28,590–34,854)) compared with UC patients (CHF 20,351 (95% CI 18,454–22,596)); mean ratio of 1.54 ((95% CI 1.34–1.77), p < 0.001). In contrast, adjusted overall daily costs were lower for sPC patients (CHF 400); mean ratio 0.87 ((95% CI 0.79–0.97), p = 0.005), mainly due to reduced diagnostic and medication costs. However, longer hospital stays (sPC 11 days vs UC 5 days) offset daily cost reductions. UC patients had nearly double the total costs of timely sPC referral patients (cost ratio 0.52, CI 0.46–0.58).Conclusion:To capture intended and unintended effects and avoid oversimplified cost debates, hospital cost analyses of sPC should examine detailed cost sub-categories rather than only total costs. Cost optimization could be reached by timely transfer of patients with sPC needs. Future studies should investigate barriers to transitioning patients across care settings to improve both quality and cost-effectiveness.

Family meetings are a core communication strategy in palliative care, but their content in routine clinical practice remains insufficiently described. This study aimed to characterize the timing, participants, goals, problems identified, and decisions reached in family meetings conducted in a specialist palliative care unit. We conducted a retrospective descriptive study of all formally documented family meetings held in a certified palliative care unit in Portugal between October 2012 and December 2019. Data were extracted from standardized meeting records and electronic health records. Variables included patient characteristics, Palliative Performance Scale scores, meeting timing, participants, goals, problems identified, and final decisions. Free-text entries were thematically recoded when needed. Descriptive statistics were used. A total of 272 formally documented family meeting records were analysed. The unit of analysis was the meeting record. Physicians attended 99.3% of meetings, nurses 65.4%, social workers 45.2%, psychologists 23.5%, and patients 11.4%. The median time from admission to meeting was 9 days, and the median time from meeting to death was 13 days. Median Palliative Performance Scale score declined from 40% at admission to 30% at the meeting. Discharge after the meeting occurred in 84 records (30.9%). Common goals included clarifying expectations, building rapport, and discussing therapeutic options. Frequently identified problems concerned prognosis, symptoms, adequacy of clinical information, end-of-life issues, and discharge planning. Common decisions related to psychological or social support, discharge planning, comfort-focused care, and symptom management. Family meetings provided a structured forum for communication, problem identification, and care planning across clinical and psychosocial domains. Their late timing and low patient participation suggest that earlier implementation and broader interdisciplinary involvement may strengthen patient- and family-centred care.

People with heart failure (HF) have unmet palliative care (PC) needs, particularly in rural areas. Collaborative care models may meet these needs by connecting primary care teams with urban palliative care specialists. We aimed to evaluate the feasibility and acceptability of the Rural Palliative Care for Patients with Heart Failure (RuPAL-HF) intervention. We recruited patients with HF from a rural Maine primary care clinic. A complex care team embedded in primary care was trained in PC. Specialty PC clinicians supported the team through weekly collaborative care meetings, providing coaching and case-specific guidance. Specialty palliative care clinicians also provided tele-PC when needed. Feasibility was assessed via recruitment, referral-to-completion rates, completion of advance care planning and surveys as well as collaborative care meeting attendance. Acceptability was assessed using qualitative methods through semi-structured interviews with patients, clinicians, and complex care team members. The intervention was feasible and acceptable to patients, clinicians, and complex care team members. 31 patients were approached, 13 enrolled, and 12 (92.3%) completed all intervention components. All patients completed a serious illness conversation with the complex care team and 11 (84.6%) with the specialty PC physician. 12 patients (92.3%) completed an advance directive and 8 (61.5%) a Portable Medical Orders Form. Patients reported that goals-of-care conversations were not overly emotionally challenging, and they valued the telehealth option. All care team members attended trainings, completed surveys, and participated in ≥90% of collaborative care meetings. Complex care team members reported increased confidence and skills after trainings. The RuPAL-HF intervention was feasible and acceptable for patients, clinicians, and complex care team members. Telehealth appeared feasible as a mechanism to support access to specialty PC. Further research is needed to evaluate this intervention in other rural sites, care teams, and health conditions.

To review the literature on the state of research on the impacts of assisted dying on nursing practice within specialised palliative care. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. PubMed, Embase, CINAHL, PsycINFO and CENTRAL were searched between July and August 2024. Articles were included if they referred to countries in which assisted dying is legally permitted and is understood as a practice that is not aligned with the philosophy of palliative care, enabling analysis of its impact on nursing practice in specialised palliative care. After the screening process, data were extracted and then synthesised using thematic analysis. Fifteen studies published between 2019 and 2024, all from Canada or the United States, met the inclusion criteria. Three themes were identified: (1) positioning and meaning, describing how nurses are required to position themselves and to renegotiate their values; (2) impact on core competencies, capturing changes in key nursing responsibilities; and (3) challenges in interpersonal relationships, referring to increased team conflicts and shifts in relationships with patients and their families. The legalisation of assisted dying impacts nursing practice in palliative care in various ways, challenging the established advanced practice role of specialist palliative care nurses. This calls for comprehensive ethical reflection within the nursing profession regarding its role and core values in this context. This review identifies significant challenges facing advanced nursing roles and the palliative care discipline. It provides a foundation for future research and ethical deliberation, with relevance for nurses, educators, policymakers and researchers involved in end-of-life care. This study did not include patient or public involvement in its design, conduct or reporting.

Death anxiety is common in advanced cancer, but little is known about risk factors for its occurrence, frequency or severity in those receiving specialized palliative care. This study aimed to determine the prevalence and correlates of death anxiety in outpatients with advanced cancer receiving specialized palliative care. Cross-sectional observational study. We identified the prevalence of death anxiety in 203 patients with advanced cancer attending an outpatient palliative care clinic in a large tertiary care hospital, and examined its association with sociodemographic factors, time since advanced cancer diagnosis, time since initial palliative care consultation, and proximity to death. Death anxiety was measured using the Death and Dying Distress Scale (DADDS). Variables that demonstrated significant univariable associations were subsequently included in a multivariable regression analysis. Moderate to severe death anxiety (DADDS score ⩾ 25) was reported by 46.3% of participants. Multivariable analysis demonstrated that greater death anxiety was associated with lower household income (⩾$100,000+ vs <$30,000: ß = -0.30, p = 0.002; $60,000-$99,999 vs <$30,000: ß = -0.27, p = 0.004; $30,000-$59,999 vs <$30,000: ß = -0.31, p < 0.001) and living alone (ß = 0.16, p = 0.03), but not with time since advanced cancer diagnosis or initial palliative care consultation, or with proximity to death. Moderate to severe death anxiety is reported by almost half of patients with advanced cancer receiving outpatient palliative care and is associated with economic disadvantage and solitary living arrangements. Further research is needed to determine to what extent targeted psychosocial and palliative interventions can alleviate such distress in this population.

Background/Aims People with life-limiting conditions often wish to have their palliative care needs met in the community. In Northern Ireland, the lack of an established process to enable prescribers working in these settings to issue a HS21 (health service) prescription to patients within their own home or care home can lead to delays in accessing medication. This service evaluation describes the implementation and assessment of a new model of prescribing, known as the pathfinder, that allowed direct community-based prescribing by medical and non-medical hospice prescribers. Methods The pathfinder was implemented in September 2024 for a 6-month trial period. Key data were collected at baseline, 3 months and 6 months, including prescribing activity, urgency and waiting times. Qualitative data were collected through focus groups and interviews, held with eight staff members at the participating hospice, including one medical and one non-medical prescriber. A stakeholder survey was distributed to those outside of the hospice who were involved in or affected by the project ( n =13) to collect additional perspectives. Results Baseline data showed multiple attempts being required to request prescriptions, with a 170-minute median waiting time from start of a homecare visit to a prescription being issued. At 6-months post implementation of the pathfinder, this had fallen to 30 minutes. Themes drawn from the qualitative data from hospice staff and other stakeholders included service enablers, barriers and challenges, outcome benefits, sustainability of the project and regional adoption Conclusions The revised model of care demonstrated a valuable role for both medical and non-medical prescribing to meet the specialist palliative care needs of patients in the community setting. Vital learning from the constraints and enablers of service delivery informed recommendations to support future prescribing sustainability, scale and regional adoption efforts. Implications for practice Key recommendations from this study include provision of sufficient training and resources for community-based prescribers, strengthening governance and accountability processes and increasing skill use of medical and non-medical prescribers in hospice settings.

Cancer is a main driver of death with serious health-related suffering. The growing body of evidence for early integration of palliative care alongside oncological treatment to optimises patient-reported outcomes is almost exclusively from high-income countries whilst the greatest need is in low- and middle-income countries (LMICs). We aimed to explore the perspectives of patients, families and clinical staff on what constitutes a feasible, acceptable and appropriate model of integrated palliative and oncology care in Zimbabwe. We conducted an exploratory qualitative study underpinned by indicators for integrated oncology and palliative care. Participants comprised healthcare professionals, patients & families. Semi-structured guides were developed and iteratively refined. Deductive framework analysis was conducted to Hui's evidence-based framework of integrated oncology and palliative care indicators. The data was then further inductively coded into the framework. Analysis of data from 45 stakeholders (n = 15 per group) identified 19 of 38 indicators (50%) aligned with Hui's model, indicating partial and uneven integration. Alignment was strongest in clinical processes (n = 9) and education (n = 5), with more limited support for administration (n = 3) and structure (n = 2). No findings aligned with the research domain. Inductive coding identified three indicators which aligned with clinical processes (routine discussion of prognosis, advance care planning and goals), clinical structure (physical environment) and education (training needs). While the Hui model is broadly applicable, substantial contextual adaptation is required. Integration cannot be achieved through coordination alone and requires system-level investment in workforce, training, infrastructure, and policy. We propose a phased "minimum package" for integration tailored to Zimbabwe and similar LMICs settings. Our findings highlight the need to strengthen multi-professional collaboration and communication in oncology settings. Although tumour board meetings involve surgeons, oncologists, radiologists, and pathologists, they do not routinely include palliative care specialists such as social workers and psychologists. Including palliative care team members could broaden discussions to address symptom control, goals of care, and communication of difficult news.Developing a contextually relevant model that incorporates both existing and newly identified indicators of integration may help patients, families, and health systems realise the benefits of integrated oncology and palliative care.

The Impact of Specialist Palliative Care on the Utilization of Health Care Services at the End of Life Among Patients With Prostate Cancer: A Nationwide Register-based Study.

Utilization and Post-Admission Duration of Palliative Care Among General Practitioner-Referred Patients: A Retrospective Cohort Study.

The aim of this paper is to assess interprofessional competence and explain factors associated with it among health and social care professionals working in specialized palliative care hospital wards. The research study employs a descriptive cross-sectional approach. The study followed good scientific practice. Ethical approvals were obtained from the Ethics Committee of Tampere University (85/2022) and the Ethics Committee of the Pirkanmaa Wellbeing Services County (6/2023). Research permits were obtained separately from each institution that participated in the study. Participation was voluntary, contingent on informed consent and the confidentiality of participants was protected. In total, 153 health and social care professionals from 16 specialized palliative care wards in Finland participated in the study. The data were collected from May 2023 to March 2024, using the previously validated generic IPEC instrument and newly developed, palliative-care-specific ICOPA self-assessment instruments. Data were analysed using descriptive and inferential statistics. Due to the data not being normally distributed, non-parametric Mann-Whitney U and Kruskal-Wallis tests were applied, depending on the number of groups compared. Pearson's correlation was used to examine associations between variables. Health and social care professionals self-assessed their interprofessional competence as good. Among the interprofessional competencies, values and ethics were assessed highest, while teams and teamwork were assessed lowest. Education level, participation in interprofessional education, work experience, amount of teamwork conducted in their own unit, and evaluation considering teamwork functionality had a statistically significant association with professionals' better self-assessed interprofessional competence. The results have identified competence gaps that will guide the development of interprofessional practice. However, because the currently used instruments are based on self-assessment, objective measures are also needed to ensure a comprehensive evaluation of interprofessional competence.

Existing evidence demonstrates the benefits of integrated palliative care for people with cancer and their carers, for improved symptom burden, quality of life and appropriate healthcare resource use. The integration of palliative care and oncology has the potential to improve the quality of life and is recommended by international guidelines. However, it is not yet consistent practice. There are many approaches to integration, but it is unclear what works, for whom and in what contexts to achieve the best possible outcomes for people with cancer, carers and healthcare systems. To conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and increased quality of life for people with cancer and their carers. To use the programme theory to coproduce, with stakeholders (e.g. patient and public involvement representatives, local, national, international content experts and multidisciplinary practitioners), guidance to inform delivery of best practice and guide future research. Realist review, conducted in accordance with Realist and Meta-narrative Evidence Synthesis: Evolving Standards. Evidence was identified through systematically searching academic databases and through stakeholder engagement. Data were extracted from included articles and were synthesised using a realist logic of analysis to develop explanations of how and why integrated palliative care in oncology works, for whom and in what contexts. One hundred and sixty-four papers from 33 countries were included in the review. Integrated palliative care and oncology could improve people with cancer's outcomes, increase the goal-concordance of care and support workforce well-being. Interventions to support integration should be tailored to the context in which they are delivered. Ensuring the timely delivery of palliative care for people with cancer requires integration that overcomes siloes between oncology, specialist palliative care and primary and community care. The motivation to prioritise the integration of palliative care relies upon all stakeholders first understanding its value. Enriched interdisciplinary collaboration involves developing confidence in their own and their colleagues' skillsets, facilitating co-ordination between care settings and supporting communication within and between teams. Supportive leadership could promote an institutional culture of acceptance of the value of integrating palliative care into oncology management. The realist approach to analysis means that findings are based on our interpretation of the data. To manage the high volume of studies, we limited inclusion to documents published since 2010, using qualitative, mixed or economic methods; therefore, we may have excluded relevant documents. The success of integration is influenced by the ways in which palliative care is understood, prioritised, operationalised and measured within oncology. Through the synthesis of international evidence, this project draws on implementation science to contribute clarity on how integrated palliative care and cancer care can be achieved in practice. Future work should use the implications and recommendations to initiate and optimise palliative care in oncology management. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR152115.

Key characteristics of palliative care integration in intensive care units (ICUs): A scoping review.