Precaution or barrier? Reconsidering contact and isolation measures in palliative care: a systematic scoping review.

Abstract

Objective: Infection control measures like contact precautions may conflict with patient-centered palliative care principles, but their efficacy and harms in this context remain understudied. This review evaluates how contact precautions affect quality of life, social connectedness, and infection control efficacy in palliative care.

Design: Systematic scoping review.

Setting: Palliative care settings (eg, palliative care units and hospices).

Participants: Adults and children receiving palliative care, with no restrictions on age or comorbidity.

Methods: English-language studies on contact precautions in palliative care were included. Ovid MEDLINE and Ovid Embase were searched from inception to December 20, 2024, using terms related to antimicrobial resistance, contact precautions, and palliative care. No publication type or status restrictions were applied. The protocol was registered on the Open Science Framework and followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.

Results: Fifteen studies were included, primarily from Germany (73%) and using qualitative methods (80%). Most focused on patients in palliative care units or hospices, though geographic and methodological limitations restrict generalizability. Common challenges included fear, loneliness, disrupted intimacy, and inconsistent protocols. Contact precautions were often bundled with other infection prevention interventions, limiting the ability to assess their specific impact. Terminology varied widely. No study directly evaluated the efficacy of contact precautions in reducing antimicrobial-resistant organism (ARO) transmission, though one pediatric study reported liberal protocols and no nosocomial ARO infections.

Conclusions: A case-by-case approach is needed to balance infection control with patient dignity and quality of life. Consistent terminology and more robust, mixed-methods research are essential to inform evidence-based protocols in diverse settings.