Background Reducing ‘avoidable’ hospital admissions towards the end of life and facilitating death at home have had considerable attention in the literature. The role of a Primary Care clinician is central to many of these decisions and should be closely examined if we are to consider how current processes may be improved. Decision making in significant frailty deserves specific attention as it is rarely acknowledged as an end of life state.

Aim To explore what is currently known about how Primary Care clinicians approach hospitalisation decisions for people who are frail and/or may be near the end of their lives.

Design Systematic literature review and narrative synthesis.

Data Sources We searched the following databases: CINAHL, Cochrane Library, Embase, MedLine, PsychInfo and Web of Science followed by reference and forward citation reviews of included records.

Results 18 research studies were identified and included: 14 qualitative, 3 quantitative and one mixed methods study. Five key themes were identified: navigating the views of other stakeholders; clinician experiences and attributes; clinicians’ interpretation of events; the perceived adequacy of the current setting and the alternatives; system factors; continuity of care and a perceived lack of choice.

Conclusion This review illustrates the number and complexity of factors influencing how Primary Care clinicians make hospitalisation decisions. The views of other stakeholders take great importance, and may be a source of conflict, and it is unclear how this should be navigated. Clinician factors, such as experience with palliative care and clinical judgement, are also important. There is significant geographical and system variation in approaches to decisions. Future research should focus on how the different aspects of the decision are balanced and to consider if, and how, this could be improved to ensure hospital admissions at the end of life are appropriate.