Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis)

Tracey McConnell*, John Burden, Claire Duddy, Loreena Hill, Clare Howie, Clare Howie, Geoff Wong, Bob Jones, Joanne Reid

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
88 Downloads (Pure)


Introduction: Heart failure affects over 26 million people worldwide with prevalence expected to grow due to an ageing global population. Palliative care can address the holistic needs of patients with heart failure, and integrated palliative care in heart failure management has been
indicated to improve outcomes for patients. Despite known benefits for integrated palliative care in heart failure management, implementation is poor across the majority of global health services. Recent systematic reviews have identified the benefits of integrating palliative care
into heart failure management and highlighted barriers to implementation. However, there was heterogeneity in terms of countries, healthcare settings, delivery by differing staff across multidisciplinary teams, modes of delivery and different intervention components.
Methods and analysis: The aim of this study is to identify how integrated palliative care and heart failure interventions produce desired outcomes, in which contexts, and for which patients. We will undertake a realist synthesis to identify this, using Pawson’s five iterative steps. We will recruit an international stakeholder group comprised of healthcare providers and patients with heart failure to advise and provide feedback throughout
the review. Our initial realist programme theory sets out the necessary steps needed to accomplish the final intended outcome(s) from the implementation of integrated palliative care and heart failure. This initial programme theory will be shaped through an iterative process of
testing and refinement.
Ethics and dissemination: Ethical approval is not required for this study. With our stakeholder group, we will coproduce a user guide that outlines practical advice to optimise, tailor and implement intervention designed to integrate palliative care and heart failure, taking into consideration local context, alongside user friendly summaries of the synthesis findings using short animations to convey complex findings. We will draw on
the expertise within the stakeholder group to identify key stakeholders for disseminating to relevant audiences, ensuring outputs are tailored for their respective needs.
Original languageEnglish
Article numbere058848
Number of pages7
JournalBMJ Open
Publication statusPublished - 07 Jan 2022

Bibliographical note

Funding Information:
Funding This project is funded by the National Institute for Health Research (NIHR) (NIHR131800 Integrating Palliative Care and Heart Failure: a Realist Synthesis (PalliatHeartSynthesis).

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.


  • heart failure
  • organisation of health services
  • palliative care

ASJC Scopus subject areas

  • Medicine(all)


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