Introduction In 2013, the policy approach to end of life care delivery in English acute hospitals underwent a significant change of direction, and is now characterised by an individualised approach to patient care, instead of a protocol-driven one.1 This systematic review identifies and analyses the barriers and facilitators to implementation of current end of life policy in the acute hospital setting, in England.
Methods This systematic review applied techniques of meta-ethnography to qualitative synthesis of the relevant literature. Barriers and facilitators to policy implementation were identified and analysed through the stepwise development of first, second and third order interpretations from the included studies.
Results Five ‘clusters’ of determinants of end of life policy implementation were identified: characteristics of healthcare professionals; policy context; characteristics of hospital context; means of policy implementation; and patient perceptions of dying. These clusters formed the central components of a new theory of policy implementation, and were further conceptualised as having the potential to act as either barrier or facilitator in the acute hospital setting. A conceptual divide between the grey literature and peer reviewed literature also emerged; the former focused on sufficiency of education for policy implementation, whereas the latter identified a complex range of other influences on delivery of end of life care.
Conclusion This review identified that there are multiple, complex determinants for the implementation of end of life care policy in acute hospitals. Bridging the gap between end of life care practice and policy therefore requires robust engagement with this complexity, at regional and national level.
. Leadership Alliance for Care of Dying People (LACDP)2014, One Chance to get it Right: improving people’s experience of care in the last few days and hours of life. [Online]. London: LACDP. [Accessed 1 June 2017]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/323188/One_chance_to_get_it_right.pdf
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