Palliative Medicine最新文献

{"title":"Beyond standard care: Fathers' perspectives on healthcare and related support services when caring for a child with a progressive life-limiting condition-A qualitative study.","authors":"Marianne Sjuls, Mette Spliid Ludvigsen, Liv Fegran, Nastasja Robstad","doi":"10.1177/02692163261486220","DOIUrl":"https://doi.org/10.1177/02692163261486220","url":null,"abstract":"<p><strong>Background: </strong>Fathers' experiences are seldom reflected in paediatric palliative care research, and existing studies predominantly focus on malignant conditions. Less is known about fathers' experiences with healthcare and related support services when caring for a child with a progressive life-limiting condition. These conditions are often marked by long and unpredictable trajectories and complex care needs.</p><p><strong>Aim: </strong>To gain an in-depth understanding of how fathers experience healthcare and related support services while caring for a child with a progressive life-limiting condition.</p><p><strong>Design: </strong>A qualitative interview study grounded in phenomenological hermeneutics.</p><p><strong>Setting/participants: </strong>Thirteen Norwegian fathers of children aged 1-18 years with a progressive life-limiting condition lasting ⩾12 months. All children lived at home and received varying levels of respite or in-home care.</p><p><strong>Results: </strong>Through the analysis, we developed three themes: (1) <i>Being David against Goliath-battling the system</i>, (2) <i>Being father to a child too complex for tick-box care</i> and (3) <i>Striving for equal recognition as caregivers</i>.</p><p><strong>Conclusions: </strong>Fathers caring for a child with a progressive life-limiting condition experience fragmented healthcare and welfare services, which place substantial advocacy and coordination burdens on families. More flexible, coordinated and father-inclusive paediatric palliative care pathways are needed to recognise parental expertise and support both parents as equal caregivers.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261486220"},"PeriodicalIF":6.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexpanthenol mouth gel for the management of dry mouth in hospice patients: A pilot study.","authors":"Nina Stoks, Tamara van Schaik, Cathelijne Verboeket-Crul, Jaap Gootjes, Loek Wagenaar, Saskia Teunissen, Everlien de Graaf","doi":"10.1177/02692163261483964","DOIUrl":"https://doi.org/10.1177/02692163261483964","url":null,"abstract":"<p><strong>Background: </strong>Dry mouth affects over 80% of hospice patients, resulting in discomfort, swallowing difficulties, and a reduced quality of life. Existing treatments are often poorly tolerated or short acting. A Dexpanthenol mouth gel was developed for hospice use; however, evaluation research is challenged by perceived patient vulnerability and limited research experience among staff.</p><p><strong>Aim: </strong>To assess the feasibility of study procedures for evaluating Dexpanthenol mouth gel in hospice patients.</p><p><strong>Design: </strong>A mixed-method cross-sectional pilot study was conducted at 14 hospices in two phases in the Netherlands from November 2022 to March 2024.</p><p><strong>Setting/participants: </strong>Patients with an estimated life expectancy < 3 months who perceived dry mouth were included; patients with mucositis were excluded. Healthcare providers working at participating hospices were involved in the study.</p><p><strong>Results: </strong>Phase 1 enrolled 28 patients; 26 started, with 14 dropping out before day 5. In Phase 2, 49 were enrolled, 42 analysed, and 28 (66.7%) completed the study. Attrition was 33.3%, mainly due to illness (64%). Healthcare providers (<i>n</i> = 24) reported clarity (95%) and task manageability (62%). Most patients reported low burden (81%), clear information (97%), and 60% wishing to continue using the mouth gel. Dry mouth (<i>p</i> < 0.001) and dry lips (<i>p</i> < 0.001) decreased; speaking ability (<i>p</i> = 0.026) and taste (<i>p</i> = 0.018) improved over time during use of Dexpanthenol Mouth gel.</p><p><strong>Conclusion: </strong>This feasibility study shows that a three-day protocol with daily application is feasible and acceptable for patients and healthcare providers in hospice settings. The Dexpanthenol mouth gel was well accepted and associated with reductions in several oral symptoms.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261483964"},"PeriodicalIF":6.4,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprescribing tools in adults towards the end of life: A systematic review.","authors":"Claire Meyerkort, Emyr Rees, Amy Page, Osvaldo P Almeida, Christopher Etherton-Beer","doi":"10.1177/02692163261483456","DOIUrl":"https://doi.org/10.1177/02692163261483456","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is increasingly common in the community, as is the risk of associated adverse outcomes. Decreasing the use of potentially inappropriate medications may be facilitated through deprescribing tools, although their effectiveness towards the end of life remains unclear.</p><p><strong>Aim: </strong>To examine the psychometric properties of deprescribing tools and associated clinical outcomes in adults towards the end of life.</p><p><strong>Design: </strong>Systematic review without meta-analysis. Eligible studies described development and application of deprescribing tools for adults towards the end of life. The ROBINS-I V2 tool assessed risk of bias. The study was registered with PROSPERO (CRD420251018366).</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane library, and grey literature were searched from 2000 until April 2025.</p><p><strong>Results: </strong>Of 4108 papers, 34 studies met inclusion criteria. Eighteen deprescribing tools were identified. The Delphi method was most frequently used for item inclusion. Definitions of end of life varied. Thirteen studies assessed reliability and/or validity; eight demonstrated reduction in the number of medicines. Clinical outcomes comparing deprescribing with control interventions were mostly non-significant, although supportive evidence existed for reduced mortality, reduced acute care referral and lower costs. Risk of bias was moderate to high.</p><p><strong>Conclusion: </strong>A range of deprescribing tools exist for patients towards the end of life. Deprescribing tools may reduce medication burden and improve outcomes, including mortality, acute care referral and medication costs. High risk of bias associated with these results limits strong conclusions regarding the validity and clinical impact of deprescribing tools used towards the end of life.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261483456"},"PeriodicalIF":6.4,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers for interdisciplinary collaboration in pediatric palliative care: A cross-sectional survey.","authors":"Maureen M Kemna, Marijanne Engel, Everlien De Graaf, A A Eduard Verhagen, Saskia C C M Teunissen, Marijke C Kars, Judith L Aris-Meijer","doi":"10.1177/02692163261482013","DOIUrl":"https://doi.org/10.1177/02692163261482013","url":null,"abstract":"<p><strong>Background: </strong>Pediatric palliative care requires input from various healthcare professionals to meet the changing needs of children and their families. Effective interdisciplinary collaboration across care settings is essential to ensure continuity and quality of care.</p><p><strong>Aim: </strong>To identify facilitators and barriers for interdisciplinary collaboration within pediatric palliative care as perceived by diverse healthcare professionals.</p><p><strong>Design: </strong>Cross-sectional survey in which participants reflected on their most recent pediatric palliative care case, using the Index of Interdisciplinary Collaboration, and reported their satisfaction with care coordination, continuity, and quality in this case.</p><p><strong>Setting/participants: </strong>Physicians, nurses, and paramedical professionals in home care, regional, and academic hospitals who had provided palliative care within the previous 3 years. As pediatric palliative care may extend over a longer period, participants reflected on collaboration during the entire care process for a now-deceased child.</p><p><strong>Results: </strong>In total, 208 healthcare professionals participated. Fifteen facilitators and six barriers were identified. Facilitators included role clarity, task flexibility, family participation, and the perceived importance and added value of interdisciplinary collaboration and included active collaboration with home care nurses, Children's Palliative Care Teams and lead clinicians. Barriers related mainly to insufficient communication, limited evaluation, and inadequate organization of interdisciplinary collaboration. Satisfaction with care coordination, continuity and quality was high.</p><p><strong>Conclusion: </strong>Improving interdisciplinary collaboration in pediatric palliative care requires strategies that strengthen organizational and managerial structures, while actively engaging both experienced and less experienced professionals across different care settings. Enhancing awareness of each other's roles, needs, and capacities is essential to foster more effective interdisciplinary collaboration.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261482013"},"PeriodicalIF":6.4,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Existential homecoming when facing death: A meta-ethnography of the end-of-life experiences of patients with a life-threatening illness.","authors":"Janet Bakken, Margrethe Aase Schaufel, Kjetil Moen, Kristine Rørtveit","doi":"10.1177/02692163261481988","DOIUrl":"https://doi.org/10.1177/02692163261481988","url":null,"abstract":"<p><strong>Background: </strong>Serious illness influences existential well-being. Dwelling is an existential dimension of well-being when coming to terms with one's situation, yet there is limited knowledge about how this may be achieved and fostered in clinical practice.</p><p><strong>Aim: </strong>To interpret and synthesise qualitative research findings about patients' experiences facing death at the end of life.</p><p><strong>Design: </strong>A meta-ethnography based on Noblit and Hare's seven-phase process was conducted.</p><p><strong>Data sources: </strong>CINAHL, Ovid Medline, APA PsycInfo, and Embase, were searched. Qualitative interview studies published between 2014 and 2025 on adult patients' experiences of facing death, with a life expectancy under 1 year, were included. Quality was assessed and considered satisfactory using the Critical Appraisal Skills Programme checklist.</p><p><strong>Results: </strong>A total of 317 patients were included. We developed an overarching metaphor, <i>Striving for existential homecoming,</i> as an interpretative understanding and synthesis of patients' experiences when facing death. To find acceptance of their situation as a sense of peace amid suffering, patients navigated extreme endpoints; <i>an ambiguity between life and death, wishing for normality while accepting and preparing for finality,</i> and <i>an intertwined loneliness and togetherness.</i> This encompassed emotional tension between accepting and defending themselves against the nearness of death. Facing fear and uncertainty, patients sought meaning and hope, striving to belong while also feeling obliged to cope on their own.</p><p><strong>Conclusions: </strong>Supporting meaning, connection, and belonging can foster a sense of \"homecoming\" for dying patients. Understanding existential homecoming may strengthen end-of-life care and should be emphasised in education and clinical practice.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261481988"},"PeriodicalIF":6.4,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Terminal discharge of the imminently dying from hospital to home: A realist evaluation.","authors":"Poh Heng Chong, Michelle Low, Zhi Zheng Yeo, Yung Ying Tan, Xiangyi Chen, Jason Tay, Komal Tewani, Lip Hoe Koh, Yoke Ping Wong, Guozhang Lee, Peiying Gan, Yu Xian Loo, Sharon Harvinder Kaur, Ami Nagashima, Grace Meijuan Yang","doi":"10.1177/02692163261485101","DOIUrl":"https://doi.org/10.1177/02692163261485101","url":null,"abstract":"<p><strong>Background: </strong>Rapid terminal discharge home is increasingly prevalent, yet processes remain inconsistent and stressful for both clinicians and families. A harmonised 'compassionate discharge' protocol was collaboratively developed by providers across settings to improve overall experience.</p><p><strong>Aim: </strong>How, for whom, and in what circumstances does the new pathway foster a positively experienced live terminal discharge?</p><p><strong>Design: </strong>A mixed-methods realist evaluation was adopted to study the novel Compassionate Discharge intervention that embedded eligibility checks, customised resources and standardised workflows. Data collected from caregivers, hospital and hospice providers through surveys, diaries and interviews were analysed using abductive and retroductive reasoning to refine early Context-Mechanism-Outcome configurations and iterate an Initial Programme Theory.</p><p><strong>Setting/participants: </strong>The multi-centre study involved referring hospital staff (<i>n</i> = 66), home hospice providers (<i>n</i> = 48), and family caregivers (<i>n</i> = 51) linked to specific patients who were compassionately discharged home alive as cases.</p><p><strong>Results: </strong>Caregiver preparedness was associated with adequate information from hospital and caregiver training, while discharge experience was associated with perceived benefits from caregiver training and hospice end-of-life support. Six contextual conditions and nine mechanisms influenced three outcomes. Key mechanisms included timely recognition of dying, aligned family decision-making, structured handovers, hospital palliative team support, and targeted instrumental and psycho-emotional support for caregivers. Ultimately, successful terminal discharges depended less on information and skills transfer than on managing uncertainty and expectations across patients, caregivers and providers.</p><p><strong>Conclusions: </strong>A protocolised pathway that spans hospital and hospice can better prepare families to support good deaths at home while improving provider experience.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261485101"},"PeriodicalIF":6.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to increase involvement of primary care clinicians in providing palliative care: A scoping review.","authors":"Yousuf Shad, Michelle Kan-Hodgson, Parm Pal Toor, Angela Gao, Nishi Parikh, Njideka Sanya, Michelle Howard","doi":"10.1177/02692163261478445","DOIUrl":"https://doi.org/10.1177/02692163261478445","url":null,"abstract":"<p><strong>Background: </strong>It is recognized that primary care clinicians have a critical role in ensuring access to palliative care in health systems. When primary palliative care has been examined at the system level, provision is highly variable, making the study of best practices challenging.</p><p><strong>Aim: </strong>The aim of this scoping review is to describe intervention components, implementation contexts, and evaluation approaches used in studies seeking to enhance palliative care delivery in primary care.</p><p><strong>Design: </strong>This scoping review followed the framework and stages outlined by Arskey and O'Malley, with a descriptive analysis.</p><p><strong>Data sources: </strong>Articles published from 2000 to 2025 were identified from MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Studies that described interventions involving primary care clinicians and their adult patients with any medical condition and which were evaluated using controlled or uncontrolled, quantitative or qualitative methods, were included.</p><p><strong>Results: </strong>The search identified 8669 abstracts and 55 studies were included. Components of interventions included (1) specialist palliative care physician support (<i>n</i> = 31), (2) multidisciplinary team-based care (<i>n</i> = 36), (3) integration of new tools and resources (<i>n</i> = 36), and (4) educational and training initiatives (<i>n</i> = 39). Most interventions were multi-faceted. Regardless of patient population, support from palliative care specialists, multi-disciplinary roles and systematic approaches to identify patients were prevalent components.</p><p><strong>Conclusions: </strong>Supporting primary care clinicians to provide palliative care is achieved through coordinated efforts to mobilize resources within the primary care setting and intentional collaboration with external specialist teams.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261478445"},"PeriodicalIF":6.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring communication between people with intellectual disabilities and hospice staff: A conversation analysis pilot study.","authors":"Andrea Bruun, Irene Tuffrey-Wijne","doi":"10.1177/02692163261482008","DOIUrl":"https://doi.org/10.1177/02692163261482008","url":null,"abstract":"<p><strong>Background: </strong>Communication challenges are key barriers for people with intellectual disabilities in accessing palliative care. However, no studies to date have closely analysed the communication between people with intellectual disabilities and palliative care staff.</p><p><strong>Aim: </strong>To assess feasibility and acceptability of conducting a Conversation Analysis study with people with intellectual disabilities and hospice staff.</p><p><strong>Design: </strong>A small-scale Conversation Analysis pilot study was conducted. Hospice consultations between people with intellectual disabilities and staff were recorded, transcribed, and analysed.</p><p><strong>Setting/participants: </strong>Three consultations with three people with intellectual disabilities, one paid carer, three hospice nurses, and one welfare officer were video-recorded in a UK hospice between April and May 2025.</p><p><strong>Results: </strong>Study procedures were deemed feasible and acceptable, enabling data collection. Most hospice patients with intellectual disabilities lacked capacity to consent and/or received in-home hospice care. This hindered recruitment due to data collection being restricted to hospice premises, and the Research Ethics Committee disallowing people who lack capacity to participate. Pain assessment was identified as a phenomenon of interest. Analysis showed an assessment involving multiple questions aimed at assessing frequency, severity, and management of the person's pain. The analysis displayed communicative challenges around brief patient answers with limited elaboration and how these were navigated by staff.</p><p><strong>Conclusion: </strong>The Conversation Analysis pilot study was deemed feasible and acceptable. Analyses of pain assessments provided in-depth detail of the communication challenges and strategies employed to navigate them. This type of study and evidence can inform future communication and assessment guidelines.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261482008"},"PeriodicalIF":6.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological distress, caregiver support gaps and associated factors among family caregivers of adults with advanced cancer: A cross-sectional study in a conflict-affected, resource-constrained setting.","authors":"Mohammed N Al Khaldi, Yasin J Barbakh, Shymaa Khalid Ahmed, Yousef I Aljeesh, Jonathan Bayuo, Hammoda Abu-Odah","doi":"10.1177/02692163261485102","DOIUrl":"https://doi.org/10.1177/02692163261485102","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of people with advanced cancer in conflict-affected settings may experience substantial psychological distress and unmet supportive care needs, yet caregiver-specific evidence remains limited.</p><p><strong>Aim: </strong>To quantify psychological distress, unmet supportive care needs and their associations among family caregivers of adults with advanced cancer in the Gaza Strip.</p><p><strong>Design: </strong>A hospital-based cross-sectional survey (May-August 2022) using the Depression, Anxiety and Stress Scale-21 and the Comprehensive Needs Assessment Tool for Cancer Caregivers. Descriptive statistics, Pearson correlations and a multivariable generalised linear regression model were used.</p><p><strong>Setting/participants: </strong>Family caregivers of adults with advanced cancer at the Turkish-Palestinian Friendship Hospital. Of 400 caregivers, 97.0% completed the survey.</p><p><strong>Results: </strong>Severe or extremely severe psychological symptoms were common (depression 33.2%, anxiety 44.1%, stress 29.6%). Information support (80.9%) and practical support (77.7%) were the most prevalent unmet need domains. Total psychological distress was moderately correlated with total unmet supportive care needs (<i>r</i> = 0.543, <i>p</i> < 0.001). In the adjusted model, total psychological distress was higher with greater unmet supportive care needs (β = 0.60, 95% CI 0.51-0.68, <i>p</i> < 0.001), and female caregivers reported higher distress than male caregivers (β = 12.20, 95% CI 6.52-17.88, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Caregivers experience substantial psychological distress and unmet supportive care needs. Routine caregiver assessment, structured information provision, navigation, and psychosocial support should be integrated into cancer and palliative care services in resource-constrained, conflict-affected settings.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261485102"},"PeriodicalIF":6.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisectoral integrated care for children and young people with life-limiting conditions: A realist review.","authors":"Abinaya Chandrasekar, Pru Holder, Mary Baginsky, Lucy Coombes, Bobbie Farsides, Gabriella Lake Walker, Fliss Em Murtagh, Mary Salama, Diane Sellers, Richard Harding, Lorna K Fraser","doi":"10.1177/02692163261483460","DOIUrl":"https://doi.org/10.1177/02692163261483460","url":null,"abstract":"<p><strong>Background: </strong>Children and young people with life-limiting conditions require input from health, education and social care. Despite consensus among stakeholders that service-integration is necessary, it is not clear how models of integrated care delivery can benefit children and their families.</p><p><strong>Aim: </strong>To determine <i>how, why, and under what circumstances integrated multisectoral assessment and care is achieved for children with life-limiting conditions?</i>Design:We conducted a realist review according to RAMESES guidelines (PROSPERO: CRD420250653996).</p><p><strong>Data sources: </strong>Iterative searches of peer-reviewed and grey literature were conducted between February and March 2025. We included documents that explain contexts and mechanisms by which multisectoral care might lead to optimal outcomes for children.</p><p><strong>Results: </strong>From 49 documents, we developed nine CMOCs representing two themes: (1) needs of children and families, and (2) agencies and systems of care. Key contexts including the co-creation of care plans, interagency working and collaborative funding systems. Mechanisms include children and families feeling reassured that care will be responsive to their evolving needs. Positive and negative outcomes were also evident: increased referrals to appropriate services, improved care experiences and a distrust of school services to meet the needs of children and families.</p><p><strong>Conclusion: </strong>This is the first realist review of multisector integrated care that considers the perspectives of health, education and social care. Policymakers should prioritise child-centred policies and cross-sector funding systems to support shared goals, information-sharing and planning care that incorporates families' views and needs. The development and rigorous evaluation of multisector programmes for children with life-limiting conditions requires further research.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261483460"},"PeriodicalIF":6.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}