Barriers to integrating hospice and palliative care into emergency units: a systematic review

Abstract

Rapid population aging has increased the demand for palliative care for critically ill and end-of -life patients. Improving quality of end-of-life care for patients and fheir families in emergency settings is a major challenge. This study aims to investigate barriers to integrating adult hospice and palliative care in emergency units. A systematic literature review was conducted following PRISMA guidelines. Relevant keywords, including "emergency department/unit," "hospice/ palliative care," "obstacles/difficulties," and "challenges," were searched in the PubMed, CINAHL, Embase, and Airiti Library databases. Articles were included for analysis if they (1) were original qualitative or quantitative studies in Chinese or English, (2) included patients aged >18 years, their families, and healthcare staff in emergency units, and (3) primarily focused on hospice and palliative care interventions. No restrictions on publication year were applied. The QualSyst tooi was used for study quality assessment. Narrative synthesis was applied to consolidate and analyze the results. A total of eight studies with quality assessment scores ranging from 90% to 95.5% were included. The following obstacles were identified: (1) variations in disease severity and a lack of understanding from family members, hindering quick resolution of complex health concerns; (2) insufficiënt knowledge of hospice and palliative care, and poor communication skills among healthcare staff, complicating decision-making and identification of patiënt care needs; (3) limited space in emergency units and the absence of dedicated areas for hospice and palliative care, restricting the ability to provide appropriate care, and (4) lack of integrated decision-making resources, creating difficulties in information access and sharing. Emergency units should increase the number of health professionals specialized in palliative care, optimize emergency department workfiows, improve infras truc ture, and establish dedicated space for hospice and palliative care provision to provide support and companionship for patients and their families. Strengthening the integration of the healthcare system and promoting a unified, real-time health information system will enable effective interprofessional information sharing among medical institutions, thereby enhancing the quality of hospice and palliative care for emergency patients. (Taiwan J Public Health. 2025;44(1):18-31)