Imbalanced psychological care provision in non-hospice-based palliative care services across England: a nationwide, cross-sectional survey

Objectives To explore patterns, variation and barriers in the provision of specialist psychological care in non-hospice palliative care settings across England. Methods A convergent mixed-methods e-survey of specialist psychological professionals (SPPs) and clinical leads in non-hospice palliative care settings across England. The 45-item survey included open and closed questions on service configuration, workforce, access, training, confidence levels and barriers and service improvement. Quantitative data were analysed descriptively and qualitative responses using content analysis. Results 19 services responded, predominantly urban based. All but one reported access to an SPP, but capacity was limited (mean whole time equivalent 0.53), with only 29% of services having full-time provision. Access to psychology was frequently restricted by diagnosis, prognosis, service eligibility or discharge status. Training provision and supervision were inconsistent, with generally high staff confidence where present. Key barriers included system fragmentation, poorly integrated Information Technology, constrained clinical space, workforce shortages and delays in accessing psychological input. Conclusions Specialist psychological provision in non-hospice palliative care remains uneven and capacity constrained. Investment in dedicated SPP roles, strengthened training and supervision infrastructure and improved cross-system integration are needed to support equitable access to psychological care.