Background: People receiving specialist community palliative care services often experience unplanned hospitalisations. A better understanding of the determinants leading to hospital use will support the development of more responsive palliative care policies and practices. Aim: To identify the contextual and individual determinants that lead to the unplanned hospital use of people receiving specialist community palliative care services. Design: A systematic review and meta-ethnographic synthesis prospectively registered with PROSPERO (CRD42022287904) and reported according to the PRISMA Statement and eMERGe guidelines. Andersen’s Behavioural Model of Health Service Use was used to frame the synthesis. Data sources: CINAHL, PubMed via the CareSearch palliative care filter, Scopus and Embase were searched in February 2024. High-income country’s studies published in English and reporting empirical qualitative data were eligible for inclusion. Results: The 12 included studies provided carers ( n = 148) and healthcare professionals ( n = 150) but not patients ( n = 0) perspectives of factors contributing to unplanned hospital use. Five constructs were the key reasons for specialist community palliative care patients’ unplanned hospital use, including service limitations and barriers, difficulty accepting death, transitions as catalysts for misunderstanding, carer burden and hospital preference. The line of argument synthesis revealed convergence across studies and showed the decision to seek hospital care is multifaceted, shaped by individual and contextual factors, culminating in unplanned hospital use. Conclusions: This meta-ethnography identified insights for developing effective person-centred initiatives aimed at reducing unplanned hospital use and opportunities for specialist community palliative care services to support patient and carer needs. Capturing patient perspectives is essential for future research.
Elvidge et al. (Wed,) studied this question.