Professional Knowledge and the Meaning of Symptom Management in Community Palliative Care

Why is the research needed?

Most people approaching the end of life wish to remain at home or in their usual place of care for as long as possible. In response, UK health policy has increasingly prioritised community-based end-of-life care, with a focus on supporting people to remain in their preferred place of care, avoiding unnecessary hospital admissions and providing proactive care closer to home. Nurses working in community and care home settings play a central role in supporting people approaching the end of life, including through the assessment and management of symptoms such as pain, breathlessness, agitation and nausea.

Although symptom management is widely recognised as a cornerstone of good end-of-life care, relatively little research has examined how healthcare professionals understand, describe and give meaning to its purpose and value. Nurses' accounts offer an opportunity to examine the professional knowledge, values and assumptions through which symptom management is understood, including how it is discussed in relation to decisions about remaining at home, hospital admission and professional responsibility.

What are we doing?

We will explore how community and care home nurses understand and describe symptom management when supporting people approaching the end of life, examining the professional knowledge, values and assumptions expressed in their accounts. The findings will contribute to a broader understanding of how symptom management is understood within contemporary community-based end-of-life care, informing future research, education and policy.

We will interview approximately 15–20 community and care home nurses from across England about their experiences of managing symptoms for people approaching the end of life. Using in-depth, semi-structured interviews, we will explore how nurses describe the purpose and value of symptom management, what they consider to constitute good symptom management, and how they talk about uncertainty, risk, comfort, deterioration, hospital admission and decisions about where care takes place.

Through analysis of these accounts, we will examine how symptom management is described, interpreted and given meaning, paying attention to the professional ideas and assumptions underpinning different understandings of good care. 

How are we working with communities, services and organisations?

We will recruit nurses through existing professional networks and have developed the research with advice from clinicians experienced in community end-of-life care. We aim to produce findings that are relevant to clinicians, educators, service leaders and policymakers. Findings will be shared through academic publications, conferences and engagement with healthcare organisations to support future research, education and practice.

What will the impact and benefits of this research be?

The research will provide new insights into how symptom management is understood and valued within community palliative care. By examining nurses' accounts, we will make visible the professional knowledge, assumptions and judgements through which symptom management is understood, including what constitutes good care and how this relates to comfort, dignity, autonomy, uncertainty and professional responsibility. This will contribute to professional education and future research by encouraging critical reflection on the meanings attached to symptom management beyond its immediate clinical purposes.

The findings will also contribute to wider discussions about contemporary approaches to community-based end-of-life care. By exploring how nurses describe the purpose and value of symptom management, the research will illuminate the professional understandings underpinning expectations around remaining at home, hospital admission and the provision of care outside hospital. This will be relevant to academic, professional and policy discussions about the future of community palliative care.

What do we have planned for knowledge mobilisation and implementation?

Our research will contribute to debates across nursing, palliative care, health services research and the critical social sciences by offering a critical account of the professional knowledge and assumptions through which symptom management is understood in community end-of-life care. We will disseminate the findings through peer-reviewed journal publications, conference presentations and engagement with clinical, academic and policy audiences. Alongside academic dissemination, we will share findings with community nursing services, care home organisations and professional networks through accessible summaries, presentations and webinars. 

Related papers, outputs and resources

Articles are forthcoming.