Healthcare providers' attitudes and associated factors on palliative care referral: A qualitative systematic review and meta‐aggregation

Abstract Background Early referral to palliative care has been viewed as providing opportunity for accomplishing end‐of‐life care goals of life closure, comfortable dying and effective grieving. However, previous studies have shown that palliative care referrals are being made too late. Healthcare providers play important role in helping terminally ill patients to early access and being referred to palliative care. It is necessary to understand healthcare providers' attitudes on palliative care referral and associated factors regarding referrals. Objectives This review aimed to identify and synthesise healthcare providers' attitudes and associated factors on palliative care referrals systematically. Design A systematic review of qualitative evidence and meta‐aggregation was conducted and guided according to PRISMA guideline. Data sources PubMed, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane databases from inception to 24 October 2022. Results Database searches yielded 5856 references. Twenty‐two studies met eligibility criteria and of moderate to high methodological quality were included. Studies occurred in USA, UK, Australia and France with 716 healthcare providers participants were included. A total of 378 codings were finally extracted and integrated into 41 categories, forming three synthesised findings: (1) Healthcare providers' attitudes towards palliative care referrals, (2) the influence of subjective norms on palliative care referral behaviour and (3) perceived behavioural control on palliative care referral behaviour. Conclusion This review demonstrates a series of factors that affect the palliative care referrals, including the attitudes of healthcare providers, the participation of patients and families, the support of colleagues and supervisors, inter‐professional collaboration, the availability of hospice resource, disease trajectory and socio‐economic factors. Further research that addresses these factors and design relevant trainings on improving healthcare providers' attitudes, enhancing patient and family engagement, strengthening support networks and optimising resource allocation may aid to meet increasing demands of patients. Relevance to Clinical Practice This review not only guides healthcare providers in making better decisions about patient referrals by identifying and addressing barriers but also aids in the development of effective interventions that facilitate the early initiation of referrals. Patient or Public Contribution No patient or public contribution.