Background: Palliative care, vital for patients with advanced, life-limiting or life-threatening illnesses, faces an increasing global demand due to aging populations and rising non-communicable diseases. Specialized palliative care teams (PCTs) within hospitals significantly impact patient outcomes, which requires effective interprofessional collaboration with general healthcare workers. Therefore, We will conduct a realist review to explore the contextual factors, mechanisms and outcomes related to the interprofessional collaboration between PCTs and general healthcare workers. Methods: Grounded in the third generation Cultural-Historical Activity Theory, this review will follow 5-step iterative process. First, a preliminary literature search will define the review scope. Second, based on the preliminary searches an initial program theory will be developed. Third, systematic searches across PubMed, Embase, CINHAL, Web of Science, and Scopus will be caried out. Fourth, data extraction of included studies will be conducted. Simultaneously, relevance and rigour of individual studies will be evaluated. Lastly, data analysis and synthesis will be conducted in which identified individual Context-Mechanism-Outcome (CMO) configurations will be combined in chains of inference through which hypotheses can be formulated. In summary, this realist review will refine an initially developed program theory, producing a framework elucidating how interprofessional collaboration works between PCTs and general healthcare workers. Discussion: This review aims to provide crucial insights into interprofessional collaboration between PCTs and general healthcare workers, informing optimized palliative care delivery in acute care hospitals for diverse stakeholders.

Context: Psychological distress symptoms in the last days of life often contribute to the overall symptom burden in frail older patients. Good symptom management practices are crucial to ensure high-quality end-of-life care in an aging population, though the best pharmacological approach to treat these psychological symptoms has yet to be established. Objectives: To identify current evidence-based and practice-based knowledge of pharmacological interventions for the treatment of agitation, delirium, and anxiety during the last days of life in frail older patients. Methods: A systematic, mixed methods review was performed through MEDLINE via PubMed and EMBASE from inception until February 2022 and updated through March 2023. National and international guideline databases and grey literature were searched for additional studies and guidelines. Results: Four quantitative studies, two non-randomized and two descriptive, were identified. No randomized controlled trials met inclusion criteria. No qualitative studies were withheld. The three consensus-based protocols that were found through citation searching and screening of grey literature did not meet the standards for inclusion. Haloperidol is recommended in consensus-based guidelines for delirium and is widely used, but high-quality evidence about its efficacy is missing. Better control of agitation or refractory delirium might be achieved with the addition of a benzodiazepine. There is no evidence available about the treatment of anxiety in the last days of life in frail older patients. Conclusions: This mixed methods review demonstrates the lack of good quality evidence that is needed to help clinicians with pharmacological treatment decisions when confronted with psychological symptoms in the last days of life in frail older patients. Population aging will only emphasize the need for further research in this specific population.

Heart failure (HF)—a highly prevalent condition among older adults—is characterized by recurrent exacerbations and progressive symptom burden, significantly affecting functional autonomy and quality of life. Palliative care may alleviate symptoms and improve quality of life for patients and their families, promoting personalized care aligned with individual preferences. Although international guidelines recommend the early integration of palliative care into standard HF management, its implementation in real-world practice remains limited. Improving awareness and competencies in identifying end-of-life needs and in advance care planning may facilitate earlier integration of palliative care into HF clinical pathways. This paper presents a case of advanced HF in which palliative care was introduced only during the final hospitalization, highlighting the importance of the earlier integration of palliative care throughout the disease trajectory. This paper results from a collaboration between young members of the Italian Society of Palliative Care and the Italian Society of Gerontology and Geriatrics. The case serves as a practical training model for healthcare professionals in applying a palliative care approach to advanced HF. It illustrates key strategies and tools employed across different stages of care, including patient identification, multidimensional assessment, shared decision-making, advance care planning, symptom management, medication review, and palliative sedation.

Background: The need for palliative care is increasing due to population aging and rising prevalence of chronic illness. Although hospital-based palliative care is typically delivered through a generalist–specialist model, limited evidence exists on how organizational characteristics of palliative care teams (PCTs) shape interprofessional collaboration with ward staff. Aim: To describe the organizational characteristics of hospital-based PCTs and examine perceptions of interprofessional collaboration from both PCT and ward staff perspectives, including an exploratory descriptive comparison between PCT characteristics and ward staff satisfaction. Design: Multicenter cross-sectional survey. Setting/participants: Acute care hospitals in Flanders, Belgium. Data were collected from 43 PCTs and 714 ward staff members. Results: All PCTs included nurses, most included physicians and psychologists, with variable involvement of social workers and spiritual caregivers. Consultations most commonly focused on end-of-life decision-making and advance care planning. Interprofessional collaboration was perceived positively by both groups. Workload and time constraints among ward staff remained important barriers. PCTs predominantly fulfilled advisory and coaching roles, which were also preferred by ward staff. Conclusion: Effective interprofessional collaboration in hospital palliative care is highly valued by both PCTs and ward staff. Advisory and coaching-oriented consultation approaches were common and generally well accepted in practice. Further research is needed to determine how organizational characteristics and consultation practices influence collaboration and support generalist palliative care within acute hospital settings.