Access and Early Integration of Palliative Care in the Non-Hospital Setting for Individuals Living with Cancer in the United States: A Mixed Methods Systematic Review.

The early integration of palliative care (PC) alongside standard cancer care is associated with decreased symptom burden, better adherence to cancer treatment, and enhanced quality of life for individuals living with cancer. The purpose of this mixed methods systematic review was to answer the following research questions (1) What are the characteristics of PC access in non-hospital settings in the US for individuals living with cancer?, and (2) What factors facilitate or deter whether PC is integrated early alongside standard cancer care? The study followed the Joanna Briggs Institute methodology for mixed methods systematic review and a convergent integrated data analysis design. The Conceptual Framework of Access to Healthcare and its five dimensions of access (approachability, acceptability, availability, affordability, appropriateness) guided the categorization and organization of the review's findings. Fifty-one studies were included and findings illuminated facilitators and challenges of PC access and early integration. While findings supported the use of traditional PC approaches for early integration, embedded PC clinics, lay navigation, and telehealth were found to be promising alternatives, especially for historically minoritized and rural populations. The results of this review led to the development of the Conceptual Framework for Early PC Access and Integration for Individuals Living with Cancer.