82 Public understandings of palliative care in three settings: home, hospice, hospital

Introduction Both professional and public misperceptions about palliative care are common and may contribute to poor access to palliative care in different settings globally. We sought to synthesise the published literature to better understand public perceptions of palliative care in different healthcare settings. Methods Non-medical subject headings (Non-MeSH) for palliative care and perceptions were used to search for relevant quantitative, qualitative and mixed-methods studies in MEDLINE, EMBASE, PsycINFO, CINAHL and, Web of Science Social Science Citations Index Expanded and Conference Proceedings Citation Index from 1 Jan 2002 to 31 May 2020. Search results were screened against a priori inclusion criteria, data extracted and quality appraised by two independent researchers. Data were analysed using critical interpretive synthesis. Results 48 of 33985 studies from Europe, North America, Asia and Australasia were included (32 quantitative, 9 qualitative, 7 mixed methods). This represented 32585 members of the public (aged 18 to 101 years; 54% women). Synthesis found considerable differences in public perception of where palliative care can be accessed. Some understood palliative care to be available in a hospice institution but less so at home. Levels of knowledge about hospice access was low and thought to be available only to those living near a hospice. Availability of palliative care in hospital was variably known, with some, viewing palliative care as only available in hospital, and that once receiving hospice care, further admissions to hospital were precluded; this likely reflects the particular use of the two terms (palliative care, hospice) in the US. Conclusion In the context of poor understanding of palliative care, public perceptions of where care is available are mixed. Terminology appears to add to the confusion. Better public understanding of where palliative care is offered may improve access to this care, improve quality of life and reduce healthcare costs.