RT Journal Article SR Electronic T1 11 Using realist evaluation to understand context, mechanisms, and outcomes of social support interventions in hospice day services JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP A5 OP A5 DO 10.1136/spcare-2021-MCRC.11 VO 12 IS Suppl 1 A1 Bradley, Natasha Mary A1 Lloyd-Williams, Mari A1 Dowrick, Chris YR 2022 UL http://spcare.bmj.com/content/12/Suppl_1/A5.1.abstract AB Introduction Our mental and physical wellbeing is influenced by our social surroundings. Patients and their families at risk of loneliness and social isolation, which can increase depression and pain, and decrease life satisfaction and coping resources.Hospices offer a range of day and outpatient services that involve a component of social support, representing an innovative area of practice – but evidence for outcomes is limited by persistent research challenges.Aims This presentation reports on PhD research into social support in palliative care (ESRC-funded 2016-2020). The project asks how the effectiveness of hospice day services might be appropriately understood, demonstrated, and improved. We aim to share findings and to reflect on the experience of realist evaluation in psychosocial palliative care.Method Using multiple research locations and mixed methods:systematic review of the literatureonline survey of hospices (n=103)longitudinal cohort study observing patient outcomes (n=30)qualitative interviews with hospice service–providers (n=19)researcher observations of hospice day services (n=12)Results Palliative care patients can experience loneliness and social isolation from the losses associated with illness, their changing support needs, and constrained emotional communication. To reduce patient loneliness, hospices might seek to facilitate reciprocal social support and collective opportunities to acknowledge mortality. Autonomy and familiarity within the group could enable reciprocity and honesty.Conclusion In some contexts, social opportunities can lead to changes in emotions and behaviour that ultimately increase resources to cope with illness and prepare for dying. This could alleviate burden on families and healthcare providers as well as improving quality of life for the patient.Impact Interventions challenging to evaluate using traditional methods can benefit from realist approaches. Dissemination and ongoing collaboration with hospices allows this work to inform practice, at a time when the sector critically reflects on the equity of service provision.