Sage Palliative Medicine & Chronic Care

Specialist palliative care improves patient experience, reduces bed days and saves money: An economic modelling study of home- and hospital-based care 27.04.2026 4min

This episode features Dr Peter May (Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, UK School of Medicine, Trinity College Dublin, Ireland). What is already known on this topic? Specialist palliative care increases odds of dying outside hospital and improves patient quality of life, but this is a complex intervention and not all who might benefit receive specialist care. Cost-effectiveness of specialist palliative care, and the economic implications of reduced hospital deaths, is a persistent question for research and policy. Prior systematic reviews identify a lack of modelling studies as a fundamental evidence gap. What this paper adds We used decision modelling, a widely-used method in health economics that has not been routinely applied in evaluating palliative care. The key strength of this approach is the capacity to combine data from different sources to estimate cost-effectiveness when there is insufficient trial data to answer the question. We found that both hospital-based specialist palliative care and home-based specialist palliative care for adults in England represent excellent value care, reducing the average cost per patient to the NHS while improving patient outcomes. Implications for practice, theory or policy Specialist palliative care is currently accessed by less than half of people who might benefit in England. Expanding access would likely yield further cost-savings and improve outcomes for patients and families. However, mitigating current inequities in access and outcomes also requires new approaches to identifying, engaging and meeting the needs of underserved groups. Other countries interested in applying these methods to their own data and services can consider using our methodological templates, which we have published open access. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163261423755 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Reasons for patients in high income countries accessing hospital care while receiving specialist community palliative care: A systematic review and meta-ethnography 27.04.2026 5min

This episode features Norah Elvidge (School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia. Silverchain, Melbourne, VIC, Australia). What is already known on this topic? Many people with palliative care needs would prefer to be cared for and/or die at home. Many people will be cared for at home by specialist community palliative care services. Despite this, hospitalisation rates remain high for people receiving specialist community palliative care services. Carers face physical, emotional and financial burden caring for someone with palliative care needs at home. What this paper adds Provides a deeper understanding of the contextual and individual determinants of why people receiving specialist community palliative care access unplanned hospital care. Provides insight into specialist palliative care carer behaviour at the end of life. Highlights the importance of the carer's role in decisions surrounding acute care access for people at the end of life. Implications for practice, theory or policy Further research is needed to capture the perspective of people receiving specialist community palliative care regarding the reasons for unplanned hospital use. The number of unplanned hospital presentations for people receiving community palliative care may be reduced through the provision of better formal support for their carers. Examining factors contributing to unplanned hospital use supports specialist community palliative care services to refine models of care and optimise care delivery. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163261418625 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Multi-perspective views about healthcare experiences for those with incurable head and neck cancer: A prospective, longitudinal, qualitative study 27.04.2026 4min

This episode features Dr Catriona Mayland (University of Sheffield, UK. Sheffield Teaching Hospitals NHS Foundation Trust, UK. Palliative Care Unit, University of Liverpool, UK). What is already known on this topic? The disease trajectory for people with incurable head and neck cancer is unpredictable. This cancer subgroup has high healthcare utilisation even in the last months of life. What this paper adds Patients, caregivers and healthcare professionals consistently reported systemic variability in healthcare experiences for those with incurable head and neck cancer. Improving access to symptom relieving medications, helping more with advocacy, and developing ways to improve caregivers' preparedness reflect areas for improvement across the disease trajectory. Information needs change over time, with initial overload, but then complexities relating to advance care planning developing later due to the unpredictable nature of the disease. Implications for practice, theory or policy Solutions include cancer centres adopting more accessible, inclusive means of communication and providing patients and families with reliable contact points for key healthcare professionals. Developing strategies or interventions to improve caregivers' preparedness should incorporate both caregivers and relevant healthcare professionals to ensure the technical aspects of care can be addressed. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163261416267 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Exploring the hidden before the end: A phenomenological analysis of forgiveness at the end of life among spiritual caregivers 27.04.2026 4min

This episode features Dr Claudia Rossy Parés (Department of Psychology, Universitat Internacional de Catalunya, Barcelona, Spain). What is already known on this topic? Research has associated forgiveness with physical, emotional and spiritual benefits in people facing the end of life. Health professionals often feel unprepared to talk about forgiveness with their patients. The role that the spiritual caregiver plays with respect to forgiveness as a need of the patient is not clear. What this paper adds By offering in-depth, qualitative insights from experienced spiritual caregivers, this paper provides data of how spiritual caregivers perceive and address forgiveness as a theme at the end-of-life in the context of severe illness. The study identifies barriers experienced by spiritual caregivers to talking about forgiveness, and proposes resources to address them. Implications for practice, theory or policy Forgiveness in palliative care should be explored and offered as a possible path toward peace within a person-centered and autonomy-respecting framework, acknowledging that not all patients wish or are ready to forgive. Spiritual caregivers need protected time and supportive conditions for spiritual conversations with patients, ensuring follow-up across care transitions when possible, and clear role boundaries distinguishing them from clergy when engaging in forgiveness conversations. Future research should include multi-faith perspectives, use diverse designs across different care settings (hospital, hospice, primary care), and integrate patients' and families' experiences to deepen understanding of forgiveness in palliative care. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163261431175 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Quality indicators for palliative care for older people: An umbrella review 27.04.2026 4min

This episode features Amy Hutchinson (Queensland University of Technology (QUT), Centre for Healthcare Transformation, Faculty of Health, Brisbane, Queensland, Australia). What is already known on this topic? Quality indicators for palliative care have been extensively researched in different populations and settings. A comprehensive suite of palliative care quality indicators for older people is required to inform policy and practice. What this paper adds This review identified 658 unique quality indicators for palliative care for older people of which 56 indicators required a person or proxy rating, 388 indicators could be derived from healthcare records, and 214 indicators related directly to service or organisational aspects. There was a clear lack of quality indicators which relate to the structures of care, demonstrating an underrepresentation of the influence of organisational processes in quality outcomes. Indicators often emphasised a biomedical approach, overlooking the psychological, social, cultural, and spiritual aspects essential to high-quality palliative care. Implications for practice, theory or policy There is a need for a more refined suite of indicators to be tested across diverse cultural, geographic and healthcare settings. This refined suite can then be used by health and aged care services to assess the quality of care they provide and identify performance gaps to target in quality improvement initiatives. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251403422 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Episode 3: Shirley Otis-Green 12.03.2026 1u 11min

E2 - Charles von Gunten 12.03.2026 1u 16min

Loading phenobarbital in paediatric home-based terminal care: A case series 24.02.2026 3min

This episode features Jo-Anne J. Kelly (Palliative Care South East, Narre Warren, VIC, Australia (Palliative Care South East, Narre Warren, VIC, Australia) and Dr Karen Aisling Griffin (Palliative Care South East, Narre Warren, VIC, Australia, Peninsula Health, Frankston, VIC, Australia) What is already known about this topic? Phenobarbital loading in the adult palliative cohort for refractory symptom management has been used for many years. However, there is little evidence, nor a guideline for palliative sedation for children at home. What does this paper add? An initial loading dose of phenobarbital may provide enhanced and quicker relief of refractory symptoms in the paediatric palliative care cohort receiving home-based terminal care. Implications for practice, theory, or policy? Further research is required to determine the efficacy of, and guidelines for administration of, a loading dose of phenobarbital for paediatric palliative care patients in the terminal phase, presenting with intractable symptoms. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251365440 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Sexual health at the end of life in patients with advanced cancer and their partners. Results of a Dutch prospective longitudinal study (eQuiPe) 22.12.2025 4min

This episode features Isabel S. van der Meer (Department of Research and Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands). What was already known? The diagnosis of advanced cancer and subsequent treatments can have negative implications for sexual health Changes in sexual health of patients with advanced cancer emerge from physical, mental and emotional transformations, but the importance of sexual health remains relatively unchanged. The majority of healthcare professionals find it challenging to discuss sexual health in the context of palliative care. What this paper adds? Patients and their partner remain relatively stable in most aspects of sexual health in the last 18 months of the patients' life. Patients' sexual desire significantly decreases in their last 18 months of life. Patients with worse physical functioning and/or prostate cancer reported a greater decline in most aspects of sexual health. Patients' sexual desire, activity and satisfaction were individually associated with the quality of life in the last 18 months of life. Implications for practice, theory, policy, or future research? Recognizing sexual health as an integral component of overall quality of life is essential. Discussing sexual health as healthcare professionals is important. Using short PROM's exploring the patient's need to discuss sexual health could facilitate the initiation of such a discussion. Future research is essential to examine whether patients perceive decreased sexual health as a concern and whether the meaning of sex changes at the end-of-life. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251385774 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Balancing present-moment acceptance and future concerns: A qualitative study of illness experiences and perceptions of palliative care in progressive neurological diseases 22.12.2025 5min

This episode features Lily Man Lee Chan (School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR). What is already known about the topic? Progressive neurologic diseases involve complex, fluctuating symptoms and function decline. Palliative care aims to improve quality of life and symptom control. Access to palliative services is often limited to advanced disease stages or based on prognosis. Palliative care needs among people with progressive neurological diseases are understudied in Asian contexts. What this paper adds? People with progressive neurological diseases experience significant palliative care needs related to physical, psychosocial, and spiritual concerns from the early stages of illness, highlighting the necessity of early palliative care based on individual needs rather than prognosis. Patients with progressive neurological diseases navigated complex psychospiritual distress, transitioning from negativity to life renegotiation by fostering acceptance, focusing on the present, and embracing a positive outlook despite ongoing disease progression and future uncertainties. Findings underscore the importance of adopting a person-centered holistic approach that incorporates psychospiritual support, suggesting a symptom-based palliative care approach. Implications for practice, theory or policy Palliative care services should proactively assess and address the multidimensional needs of people with progressive neurological diseases from diagnosis onward, not only at advanced stages. Health professionals need to integrate psychospiritual care and facilitate timely, open conversations about future care preferences before cognitive decline occurs. Policy and service development should enable needs-based, flexible access to palliative care for people with progressive neurological diseases, and promote education for patients, families, and providers on the benefits of early palliative involvement. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251394908 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Loading phenobarbital in paediatric home-based terminal care: A case series 22.12.2025 3min

This episode features Jo-Anne J. Kelly (Palliative Care South East, Narre Warren, VIC, Australia (Palliative Care South East, Narre Warren, VIC, Australia) and Dr Karen Aisling Griffin (Palliative Care South East, Narre Warren, VIC, Australia, Peninsula Health, Frankston, VIC, Australia) What is already known about this topic? Phenobarbital loading in the adult palliative cohort for refractory symptom management has been used for many years. However, there is little evidence, nor a guideline for palliative sedation for children at home. What does this paper add? An initial loading dose of phenobarbital may provide enhanced and quicker relief of refractory symptoms in the paediatric palliative care cohort receiving home-based terminal care. Implications for practice, theory, or policy? Further research is required to determine the efficacy of, and guidelines for administration of, a loading dose of phenobarbital for paediatric palliative care patients in the terminal phase, presenting with intractable symptoms. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251395457 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Palliative care and assisted dying: Uneasy bedfellows 22.12.2025 5min

This episode features Professor Nancy Preston (International Observatory on End of Life Care, Lancaster University, Lancaster, UK) and Professor James Downar (Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada) This podcast summarises a editorial which describes the critical intersection of palliative care and assisted dying where legalization has occurred. The authors address how palliative providers are likely to encounter requests for assisted dying, as currently 75–90% of requests come from people who are being treated by palliative care providers or who are admitted to palliative care facilities. The episode challenges the argument for separating these practices, suggesting that integration better supports patient values. It also explores the emotional impact on healthcare workers and the spectrum of their involvement. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251365440 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

A qualitative study exploring the perceptions and understandings of advance care planning by people with treatable but not curable cancer 03.10.2025 5min

This episode features Professor Sheila Payne (International Observatory on End of Life Care, Health Innovation One, Lancaster University, Lancaster, UK). What is already known about the topic? Advance care planning is considered good practice in palliative and end of life care and is promoted in health policy. There is no standardised approach to advance care planning in practice. There is recent debate about the utility and effectiveness of advance care planning in palliative care contexts. What this paper adds Most patients did not recognise the concept of advance care planning and did not welcome conversations with health care providers about future planning despite many participants having done this prior to interview. Patients with treatable but not curable cancer live with uncertainty of prognosis in the context of ongoing and new treatment options, making advance care planning problematic. Most patients preferred to discuss future care, social and funeral arrangements within families, if at all. Implications for practice, theory or policy The principles of future care planning can be introduced early in treatment without making them specifically about planning for the last days of life. Healthcare professionals in cancer and palliative care may need to ensure that future care planning discussions evolve over time, with decisions made being routinely revisited in light of changes in disease progression, treatment options and prognosis. Future policy guidance on advance care planning needs to take account of the changing treatment landscape for those with treatable but not curable cancer. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163251363752 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Enhancing the wellbeing of refugees living with advanced life-limiting illness in high-income resettlement countries: A systematic review 18.08.2025 4min

This episode features Dr Heidi Merrington (School of Public Health, The University of Technology Sydney, Sydney, NSW, Australia) and Professor Angela Dawson (School of Public Health, The University of Technology Sydney, Sydney, NSW, Australia). What is already known about the topic? In high-income countries, refugees experience barriers to accessing health care that may delay palliative care seeking. Refugees' cultural backgrounds and experiences of trauma, loss and grief during forced displacement shape health, wellbeing and expectations of care. Evidence is needed to inform palliative care services and approaches to supporting resettled refugees and their families. What this paper adds This review demonstrates the dearth of research focused on resettled refugees living with advanced life-limiting illness and their families in high-income countries. The review highlighted the importance of assets such as resilience, sense of identity and belonging, community connections, social support and social capital, for enhancing the wellbeing of refugees and their families during end-of-life care and bereavement. Refugees' cultural identity, death literacy and experiences of grief influence engagement with palliative care staff and decision-making about end-of-life care approaches. Implications for practice, theory or policy Community networks play an important role in end-of-life care and bereavement support for refugees and their families. Participation of diverse groups of refugees in co-designed research is needed to build an evidence base to inform palliative care service approaches and develop community-based end-of-life care interventions that strengthen assets that enhance refugee wellbeing. Future studies should focus on refugees as a distinct group compared to migrants and the general population in high-income resettlement countries. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163251338583 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Asian family members' participation in advance care planning: An integrative review 09.06.2025 3min

This episode features Jing-Da Pan (Department of Oncology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong Province, China School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong Province, China) What is already known about the topic? Family members are crucial in advance care planning for patients with life-limiting illnesses, particularly in Asia, where cultural values stress family-centeredness and paternalism. No study so far has attempted to systematically synthesize this information within the Asian context and there is a lack of a model to describe Asian family members' involvement in advance care planning. What this paper adds? Asian family members are willing to participate in advance care planning but face difficulties in translating this willingness into action. Barriers include inadequate legislation, insufficient public education, and influences from Confucianism or traditional beliefs. A culturally sensitive model with six dimensions was developed to illustrate Asian family members' participation in advance care planning. Implications for practice, theory, or policy Asian governments should enact advance care planning legislation to ascertain its legal status and allocate more relevant resources to educate the public to overcome the barriers to Asian family members' participation in advance care planning. Future efforts in advance care planning in Asia should prioritize developing culturally sensitive models which align the willingness, beliefs, and actions of Asians and the proposed conceptual model should be verified by more advanced statistical tests, thus confirming its validity in different Asian regions. Due to the paradoxical impact of filial piety on advance care planning, a culturally specific intervention is needed to help family members understand that respecting dying patients' decisions is a filial act, ultimately improving their involvement in advance care planning. Full paper available from: https://journals.sagepub.com/doi/10.1177/02692163251317856 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

The experience of nurses when providing care across acts that may be perceived as death hastening: A qualitative evidence synthesis 09.06.2025 4min

This episode features Victoria Ali (Lancaster University, Lancaster, UK. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK) What is already known about the topic? Nurses deliver care for patients and those important to them across acts that may intentionally or potentially hasten death, navigating this care within the boundaries of healthcare systems and professional regulation. The increase in permissive legislation relating to assisted dying is challenging healthcare professionals to consider how an assisted death sits alongside accepted or 'traditional' healthcare practices at the end of life. Providing care in these situations can be challenging and requires emotional labour to navigate. What this paper adds? This review allows recognition of how the emotional labour involved in providing care, and its subsequent impact, is often better recognised within assisted dying than for other acts that may be perceived as death hastening. The 'normalising' of care, and consequently dying, within acts that may be perceived as hastening death limits the recognition of the emotional labour required for nurses to provide care in these circumstances. When supporting a patient through an assisted death, nurses focus on optimising the experience for the patient, whereas in other acts that may hasten death, nurses' primary focus is on the experience of those present with the patient. Implications for practice, theory, or policy The impact on nurses' emotional well-being due to the expectation to engage in significant emotional labour, in all care that may be perceived as death hastening, should be considered in daily practice, policy and organisational structure. The provision of emotional support should be considered for nurses when involved in the delivery of care that may hasten death, either through intentional acts (an assisted death) or unintended consequence of the care. Normalising care that may be perceived as death-hastening can impact nurses' feelings of agency within care delivery and may need to be considered in jurisdictions with permissive assisted dying legislation as these practices embed within organisations. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163251331162 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Changes in perception of prognosis in the last year of life of patients with advanced cancer and its associated factors: Longitudinal results of the eQuiPe study. 27.02.2025 4min

This episode features Moyke Versluis (Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Graduate school of Social and behavioral sciences, Tilburg University, Tilburg, The Netherlands). What is already known about the topic? Patients who are aware of their limited prognosis are more likely to be actively involved in advance care planning. Many patients with advanced cancer are unaware of their limited prognosis. What this paper adds? More patients with advanced cancer become aware of their limited prognosis during their last year of life. Some patients do not want to know their prognosis, and their wish to not know their prognosis is persistent during their last year of life. Implications for practice, theory, or policy It is important for physicians to recognise that the patients' perception of prognosis may change as the disease progresses and to invite patients to discuss their needs and wishes regularly. Although some patients may prefer not to know their prognosis, it remains important to respectfully explore their preferences and wishes for end-of-life care. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163241301220 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Components of home-based palliative and supportive care for adults with heart failure: A scoping review 27.02.2025 4min

This episode features Dr Madhurangi Perera (Cancer and Palliative Care Outcomes Centre, School of Nursing and Australia Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia) What is already known about the topic? Providing palliative and supportive care in the home setting for people with heart failure is advantageous because care can be provided in accordance with an individual's way of life. Home-based palliative and supportive care for people with heart failure has the potential to improve person and caregiver outcomes and reduce healthcare costs. What this paper adds? The components of home-based palliative and supportive care are symptom management; expert communication; multidisciplinary team involvement; continuity of care; education; end-of-life discussions; and caregiver support. While initiation of care, the services provided in the home-setting and health care approaches provided differed across the reported studies, in all included studies, nursing staff were strategically placed to provide a wide range of services in the home-setting. Continuous and early liaison between cardiology, palliative care and primary care providers is needed to provide continuous, non-fragmented care. Implications for practice, theory, or policy The detailed findings of this review which highlight the components of home-based palliative and supportive care can provide guidance to enable health care providers to tailor care for this population. Future research into the perspectives of people with heart failure on each of the identified components and their implementation will assist service providers to gain a better understanding of how to enable home-based palliative and supportive care for persons with heart failure. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163241290350 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysis 06.02.2025 4min

This episode features Amy Brown (Marie Curie Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK. Swansea University Medical School, Swansea University, Swansea, UK) What is already known about the topic? The third World Health Organization Global Patient Safety Challenge 'Medication without harm', emphasises the need for improved infrastructure through better reporting practices and cross-organisational learning from adverse events and near misses. Medication is implicated in one-fifth of serious palliative care patient safety incidents, with approximately 25% of these incidents involving continuous subcutaneous infusions. Inadequate analysis of continuous subcutaneous infusions as safety-critical, risk-prone interventions dependent on complex structural and human factor issues is a lost opportunity for learning. What this paper adds? Continuous subcutaneous infusion incidents occur across all settings including the home, hospices and hospitals and particularly after the transfer of patients between settings with harm present in nearly three-quarters of reports. Multiple points of system failure were identified in continuous subcutaneous infusion incident reports including monitoring and supply (405, 31%), administration (383, 29%) and prescribing (268, 20%); recurring contributory factors included discontinuity of care within and between care settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Narrative descriptions of psychological and social harm, alongside physical harm risk, are not being adequately recognised or responded to through existing approaches to measure harm in palliative care, hindering learning in practice Implications for practice, theory, or policy The structural changes needed to minimise harm and maximise safety in palliative care are likely to be replicated in other parts of the world where patient safety reporting practices are less well established, for example, shifting from focussing on lack of experience and competency at an individual practitioner-level to addressing deficits in working environments and infrastructures for care provision. When patients move between care locations, more attention should be given to the timeliness and effective transfer of medication management (e.g. if someone is discharged from hospital to a care home that rarely uses continuous subcutaneous infusions for palliative care, this needs to be preceded by refreshing staff skills and ensuring they can access further community support if needed). Professional training and further research are needed to increase quality of reporting of psychological and social harms (including for families and other stakeholders involved) to facilitate organisational learning and pinpoint precise targets for further improvement. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/02692163241287639 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

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