6213 Scoping review of the barriers and facilitators to paediatric palliative care referral, and interventions to improve access

Objectives Palliative care is an essential component of national health systems and should be available to all people irrespective of age.1 Despite this, a large proportion of children and young people (children) worldwide who require palliative care do not receive it.2 It is necessary to assess existing evidence to inform feasible, acceptable, and effective mechanisms to facilitate referral and access to palliative care for children. This study aimed to assess the extent and type of evidence regarding barriers and facilitators of referral and access to palliative care for children, and interventions used to reduce barriers and improve access. Methods The Arksey and O'Malley scoping review methodological framework,3 incorporating recommendations by Levac et al,4 informed the review. Five electronic databases were searched (CINAHL, MEDLINE, PsycINFO, EMBASE, and Cochrane Library) for primary studies of any design, and literature or systematic reviews. Papers that reported stakeholder data in relation to referral of children with a life-limiting condition to palliative care services, in any setting, were included. Results 196 articles met the inclusion criteria. Results were reported using the five levels of the socioecological framework (individual, interpersonal, organisational, community and society). Key barriers and facilitators identified at each level included: 1) Individual level: child demographic factors, parental attitudes and treatment expectations, and staff understanding and beliefs; 2) Interpersonal level: family support, patient-provider relationships, and staff communication; 3) Organisational level: referral protocols, and staff workforce and leadership; 4) Community level: cultural norms, community resources, and the effect of geography; 5) Society level: policies and legislation, national education, the economic environment, and medication availability. 41 papers looked at interventions to improve referrals to palliative care, including: educational programs, patient screening tools, telehealth, palliative care policies/guidelines, and research dissemination tools. Conclusion There is a plethora of literature on barriers and facilitators to referral and access to palliative care for children across all levels of the socio-ecological framework. There is a paucity of literature on the development of interventions to reduce barriers and increase referral to palliative care. Next steps are to identify, adapt if necessary and test intervention(s) to facilitate referral and access to palliative care for this group. References Palliative care, World Health Organization, 2020. Palliative care for children, World Health Organization, 2023. Arksey H, O'Malley L. Scoping studies: towards a methodological framework, 2005. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology, 2010.