Bridging the Gap: An Updated Systematic Integrative Review of Palliative Care Integration in Hematological Malignancies.

Abstract

Objectives: To update our previous systematic review by assessing gaps and changes in palliative care for patients with hematological malignancies ten years on, to identify emerging themes in palliative care delivery and to provide recommendations for enhancing palliative care integration within hematology services.

Methods: We comprehensively searched PubMed, CINAHL, Cochrane, Scopus and Web of Science for articles published from 1 July 2015 to 30 December 2024, then extracted and synthesized the data using the integrative method described by Whittemore and Knafl. To enable us to focus on changes in practice and emerging trends over the 10 years elapsed since the period covered by our previous review, we excluded the 99 articles analyzed previously.

Results: Of 1605 articles identified, 68 were included in our final analysis. We identified six themes: access and referral to palliative care; end-of-life care; symptom burden and clinical management; home care; emotional and psychological support; and miscellaneous aspects of palliative care. Patients with hematological malignancies have a similarly high or higher symptom burden as those with solid tumors, yet palliative care for hematological patients remains underutilized. Access barriers to palliative care for this high-risk population include misconceptions about the role of palliative care, lack of communication between palliative and hematological teams, clinician's own shortcomings with respect to their knowledge, experience and training, and institutional barriers. Where palliative care is used, consultations tend to happen when the patient is already in the late stages of disease.

Conclusions: The evidence for the benefits of palliative care for hematological patients points overwhelmingly to improved symptom management and better emotional and psychological support for those nearing the end of life. Initiatives are needed to tackle the negative connotations of the term "palliative" so that patients may gain access to palliative care sooner. Gaps in clinicians' own knowledge and experience should be addressed through comprehensive training and awareness-raising programs to remove barriers to accessing palliative care.

Implications for nursing practice: Nursing insights have highlighted the challenges of caring for patients with hematological malignancies within a healthcare system primarily focused on cure. As nursing professionals are uniquely positioned to bridge the gap between curative and palliative approaches, they carry out multidimensional assessments and prioritize interdisciplinary collaboration in patient care. Strengthening collaboration between nurses and hematology specialists could support improved long-term planning and timely access to palliative care for patients with hematological malignancies.