Conectar
Avoidable and unfair variation in access to palliative care exists for different groups of people and communities. Primary and community care teams deliver most palliative care and care to people at the end of life at home but the quality of care provided is variable. This is an under-researched area and receives little attention in service design and policy. This study will investigate the key contexts, resources and components required for an integrated approach to palliative care to deliver improved and more equitable outcomes for patients and carers.
This mixed-methods study adopts a realist methodological approach, and comprises four work packages:
A multi-perspective mixed-methods study to understand patient preferences and priorities in palliative care, prioritising recruitment of patients and family members/carers from areas of socioeconomic deprivation. Data collection will comprise: (1) qualitative interviews, (2) review of patient case notes and (3) a discrete choice experiment. Realist analysis will result in the development of theory based on the identification of the key contexts and underlying mechanisms required to achieve beneficial outcomes through an integrated approach to palliative care.
A realist evaluation of existing integrated models of palliative care will involve theory-refining interviews and theory-consolidating focus groups with professionals working in three different service areas.
Dynamic simulation modelling of the healthcare resources needed to deliver the proposed integrated approach, ensuring quality and equity.
The theoretical and economic modelling will be tested out at two expert stakeholder workshops to determine the key enablers to implementation in practice.
The study design was informed by patient and public involvement (PPI) with 16 patients and members of the public from diverse and socioeconomically deprived communities for 12 months in a National Institute for Health and Care Research-funded palliative care partnership. PPI will be continuous throughout the study, prioritising inclusivity.
Ethical approval was obtained from the East of Scotland Research Ethics Service Research Ethics Committee 2, on 20 August 2025 (IRAS ID: 354755) and Health Research Authority approval on 1 October 2025. The targeted dissemination strategy will include outputs and resources for key audiences including patients and families, professionals in primary care and specialist palliative care and service commissioners. The results will inform service delivery to reduce inequities and optimise the use of finite resources to maximise impact.
The study is registered with the ISRCTN UK Clinical Study Registry: https://www.isrctn.com/ISRCTN61092011.
To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings.
Qualitative evidence synthesis.
We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist.
We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting–connecting with animals, growing–engaging in AAI and nurturing–making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings.
This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings.
This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed.
A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.
To explore the factors that influence the implementation of animal-assisted intervention (AAI) for people with dementia in community care settings in Ireland.
Descriptive qualitative study.
Semi-structured interviews were carried out with 13 people with dementia, 11 care partners and 18 health and social care practitioners from November 2024 to June 2025. Interviewees were recruited from 10 community care settings and local dementia networks across 11 counties in Ireland. A photo elicitation approach was applied. Framework method was used for data analysis, integrating the Consolidated Framework for Implementation Research (CFIR).
A variety of AAI types were used across community care settings. The complexity and variation in AAI delivery and factors that influence its implementation were described. We developed four themes and 11 subthemes to illustrate the inter-relationship among factors combining five domains of CFIR: attitudes toward AAI; available and accessible resources; design and development of AAI; and scaffolding to facilitate AAI implementation.
AAI has promising benefits for people with dementia. Our findings provide rich insights into the multi-level factors that influence AAI practice. Future research should focus on developing and enhancing implementation strategies, applying user-centred design, to address barriers, leverage facilitators and tailor to local context, ultimately increasing the adoption and impact of AAI.
The findings contribute to the evidence base for best practices of AAI, inform the development of strategies, guidelines and policies of dementia care, and foster the creation of a dementia-friendly community.
Two patients and members of the public (both co-authors) and four advisory group members who share a love of animals were involved in this study, contributing to the research design, recruitment, data analysis and final paper.
FreshRSS