Equitable inclusion of patients with cancer on the palliative care register: a systematic review in primary care.

Abstract

GPs are instrumental to palliative care in the UK and most practices maintain a register of patients with palliative care needs. However, many people with incurable cancer who could benefit from palliative care are not included on this register, making this a potential source of end-of-life inequity. To identify barriers and facilitators to recognising the palliative care needs of patients with cancer in the UK and understand how these factors may have an impact on those vulnerable to end-of-life inequity. A mixed-methods systematic review. Eight electronic databases (Alternative Medicine, CINAHL, Embase, Medline, PsycINFO, Scopus, SocINDEX, and Web of Science) and two preprint servers (medRXiv and Open Science Framework) were searched in November 2024. Qualitative, quantitative, and mixed-methods studies were included. Narrative synthesis was used to integrate study findings, with resulting barriers and facilitators mapped onto the COM-B model domains of capablity, opportunity, and motivation. The impact on equity was evaluated using the PROGRESS-Plus framework. Searches returned 7190 citations, with 24 studies included in the review. Seven themes were identified, with barriers and facilitators mapped onto COM-B domains: conceptualisation of palliative care; navigating challenging conversations; healthcare organisation; patient help-seeking; time and resource constraints; perceptions shaping practice; and cognitive associations. There was insufficient evidence about the barriers and facilitators that may be having an impact on those vulnerable to end-of-life inequities. GPs experience many barriers to recognising palliative care needs. There is a need for greater understanding of the extent and nature of inequities in recognising such needs, to ensure strategies to increase recognition do not widen inequities.