Barriers and Facilitators Influencing Referral to Home-Based Palliative Care: An Integrative Review.

Abstract

Most people prefer to spend their final weeks of life in the comfort of their own homes; however; only few do so. Although home-based palliative care (PC) is widely available, referrals are often made late or are missed. This integrative review, conducted according to Whittemore and Knafl's framework, aimed to identify barriers and facilitators influencing referral to specialized, home-based PC for adults with life-threatening conditions. Three databases were searched for studies reporting on factors influencing referral to specialized, home-based PC. Upon screening 26,608 citations and reviewing 115 full-texts, 17 articles were included for data extraction, critical appraisal, and content analysis, according to Whittemore and Knafl's guidance. Referral barriers concerning patients and families include resistance to PC, lack of knowledge and misconceptions about PC, reluctance to having home visits, and current care needs. Referral barriers pertaining to health care professionals (HCPs) include lack of knowledge and misconceptions about PC, discomfort with dying, clinical burden, patient ownership, prognostication challenges, and ineffective partnership with the PC team. Health care system barriers to referral are lack of standardization and restrictive criteria of home-based PC. Referral facilitators relating to patients and families include education and unmet needs. Referral facilitators regarding HCPs involve and effective communication. A health care system referral facilitator is loosening restrictions regarding eligibility and insurance coverage. This review underscores the need to educate patients, families, and HCPs regarding PC; promote effective communication; and facilitate system coordination to enhance patient outcomes and enable home-based PC referrals.