Five qualitative studies were selected for the synthesis. Sample sizes (where reported) ranged from 10 to 96. Three studies were considered to be good quality and two were poor quality according to CASP criteria.
All five studies found that involving specialist palliative care in a collaborative approach would ensure good quality end-of-life care; also recommended was the collaborative development of guidelines for referral and care pathways and an integrated approach to care planning. There was no suggestion that specialist palliative care professionals should take over as key workers.
The five studies selected for the synthesis and other studies of lesser quality were incorporated in the reporting of the following results:
Barriers to collaborative working: Themes included reluctance and lack of confidence in terms of cardiology and respiratory specialists willingness to acknowledge or discuss movement of the disease to the palliative stage. COPD patients were reluctant to accept the life-limiting nature of COPD or its transition to palliative stage. Lack of communication and location of teams involved in integrated care were cited as barriers to collaborative working. Recommendations were made for more targeted education and development of appropriate referral criteria and guidelines.
Organisational issues with consequential recommendations for the collaborative approach: Themes included the need for collaboratively-developed referral criteria and care pathways, use of standardised assessment criteria, improved communication skills, education and networking/relationship building between primary and secondary care. Further details were presented in the paper.
Patients' and carers' views of palliative care: Themes included the need for appropriate communication and continuity of professional care (possibly involving a key worker). Further details were presented in the paper.