The Rationalities 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 achieving these ambitions 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 its purpose or how it shapes wider decisions about care. Managing symptoms is not only about relieving distress; it also influences decisions about whether someone can remain at home, when hospital care is considered necessary, how responsibility is shared between professionals and families, and what is understood as good end-of-life care. This study will explore how community and care home nurses describe and make sense of symptom management in everyday practice, providing new insights into the professional ideas and assumptions that underpin contemporary approaches to end-of-life care. The findings will help inform future research, education and policy concerned with delivering high-quality end-of-life care in community settings.

What are we doing?

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 of symptom management, how they explain good symptom management, and how they reason about uncertainty, risk, comfort, deterioration, hospital admission and decisions about where care takes place.

Rather than treating these interviews simply as accounts of individual practice, we will examine how nurses construct and rationalise symptom management within everyday clinical work. This will explore how wider ideas about good care, professional responsibility, patient autonomy, remaining at home, and avoiding unnecessary hospital admissions are understood, negotiated and made meaningful in practice. By examining the ways nurses talk about symptom management, we aim to generate new insights into the broader values, assumptions and political rationalities that shape community end-of-life care and contemporary approaches to dying.

How are we working with communities, services and organisations?

We will recruit nurses through existing professional networks; we 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. By exploring how nurses understand and construct the purpose of symptom management, we will contribute to wider discussions about the future organisation of community end-of-life care, including anticipatory care, care at home, hospital avoidance and professional education. Findings will be shared through academic publications, conferences and engagement with healthcare organisations to support future policy, research and practice.

What will the impact and benefits of this research be?

We will provide a broader understanding of symptom management by showing how it functions not only as a clinical activity but also as a way of organising care, negotiating uncertainty and shaping decisions about where and how people receive end-of-life care. Our findings will make visible aspects of community nursing work that are often taken for granted, including the judgement, coordination and negotiation involved in supporting people approaching the end of life. This will contribute to professional education and future research by providing new ways of understanding the complexity of symptom management beyond its clinical outcomes.

We will also contribute to wider discussions about the future of community end-of-life care. By examining how nurses construct the purposes and value of symptom management, we will provide evidence about the assumptions that underpin contemporary approaches to caring for people at the end of life. This will inform academic, professional and policy debates about community care, nursing practice and the organisation of end-of-life care as increasing numbers of people die outside hospital.

What do we have planned for knowledge mobilisation and implementation?

We will disseminate the findings through peer-reviewed journal publications, conference presentations and engagement with clinical, academic and policy audiences. Our research is intended to contribute to debates across nursing, palliative care, health services research and the critical social sciences by providing a new conceptual understanding of symptom management in community end-of-life care. We will share the findings through national and international conferences and published in journals relevant to end-of-life care, nursing, health policy and medical sociology.

Alongside academic dissemination, we will share findings with community nursing services, care home organisations and professional networks through accessible summaries, presentations and webinars. Our research will contribute to discussions about professional education, service development and policy by encouraging reflection on how symptom management is understood, valued and organised within contemporary community end-of-life care. We will engage with clinicians, educators and policymakers throughout dissemination to help ensure that the findings inform ongoing conversations about the future of community-based end-of-life care.

Related papers, outputs and resources

Articles are forthcoming.