City Research Online

Abstract

Inequality in referrals to hospice care is a well-documented issue in the UK and beyond. Such inequality may persist within hospice services, remaining unnoticed due to a combination of factors, including limited research in this area as well as systemic, financial, and societal influences. Psychological support is a vital component of holistic care. In UK hospices, psychological support is delivered by a range of health and social care professionals as part of a stepped care model, where patients with more complex psychological needs are referred to psychological specialists, that is, professionals with specific training in mental health. At present, it is unclear what contributes to hospice staff decisions to refer, or not refer, patients and those close to them for specialist psychological support.

This study aims to explore the underlying reasons for referrals to specialist psychological support in hospice care and to provide recommendations for improving the referral pathway.

For this, fifty-two health and social care professionals working across eight UK hospices took part in nine focus groups and four individual interviews. These were facilitated by a trainee counselling psychologist. Reflexive Thematic Analysis, grounded in critical realist ontology and constructivist epistemology, was used to analyse the data.

Six themes were constructed from the data: It’s About the Formulation; Intuition is Important; It’s Beyond Me; A Gap Between the Need and Resources; Specialist Psychological Support is Not a Good Fit for Everyone; and Patient’s Agency.

The findings indicated that decisions to refer for specialist psychological support in hospice care go far beyond identifying a list of problems in the patient. Instead, they reflect a complex interplay of factors, including systemic issues such as difficulties liaising with external services and individual clinician factors such as distress tolerance. The study highlighted the role of psychological specialists not only in working directly with patients but also in supporting staff through training and supervision. It also demonstrated the scarcity of psychological specialist resources available to hospice patients. Recommendations for psychological specialists include working more closely with staff around the patient, especially when the patient declines direct involvement. They also involve being curious about the reasons for referrals, to identify and respond to the needs of both the patient and the staff who initiated the referral.

Publication Type:	Thesis (Doctoral)
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RT Nursing
Departments:	School of Health & Medical Sciences > Department of Psychology & Neuroscience School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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