Supporting homecare workers to provide palliative and end-of-life care: A scoping review of interventions and their implementation.

BACKGROUND: Social homecare workers provide care to enable people to live as independently as possible in their own homes. They play a central role in supporting palliative and end-of-life care but often encounter challenges and can feel disempowered. OBJECTIVES: We aimed to scope the evidence on interventions to support homecare workers' provision of palliative and end-of-life care, and the contextual factors that influence their implementation. ELIGIBILITY CRITERIA: Papers were included if they reported primary research of any design, evaluating any intervention supporting homecare workers to provide palliative and end-of-life care. SOURCES OF EVIDENCE: We systematically searched four bibliographic databases and supplemented this with reference chaining and grey literature searching. CHARTING METHODS: Using a qualitative content analysis, we deductively mapped data against the four contextual domains of the Practical Robust Implementation and Sustainability Model. RESULTS: We found 13 papers reporting interventions to support homecare workers to provide palliative and end-of-life care, of which only seven described contextual factors that influence their implementation. The most common intervention type was training, and most cited contextual factors related to homecare workers' perspectives of the intervention. Characteristics relating to homecare workers' schedules and agency staff turnover were also described as influencing implementation of interventions. However, few reported the influence of the perspectives or characteristics of managers, people receiving homecare, and families. Only two of the seven papers mentioned the influence of the external environment or infrastructure to promote implementation and sustainability of interventions. CONCLUSIONS: The scarcity of evidence on interventions and their implementation is a missed opportunity to support the homecare sector's response to increasing demand for community-based care and reduced hospital deaths. Better understanding of how the workforce can be supported to provide palliative and end-of-life care, in a sustainable way, would help facilitate high-quality care at home for people approaching the end of life.