The impact of a new public health approach to end-of-life care: A systematic review.
BACKGROUND
Communities play an increasingly significant role in their own health and social care, and evidence demonstrates the positive impact of this work on a range of health outcomes. Interest is building regarding the application of the principles of the new public health approach to those facing the end of life and their families and communities.


OBJECTIVE
To review the evidence relating to the impact of a new public health approach to end-of-life care, specifically as this applies to efforts to strengthen community action.


METHODS
A systematic review employing narrative synthesis. Both meta-ethnography and the use of descriptive statistics supported analysis.


METHODS
Eight databases (AMED, ASSIA, BiblioMap, CINAHL, Cochrane Reviews, EMBASE, MEDLINE and PsycINFO) were searched from the earliest record to March 2015 using set eligibility criteria.


RESULTS
Eight articles were included in the analysis. Three main themes emerged from the meta-ethnography: making a practical difference, individual learning and personal growth and developing community capacity. The quantitative findings mapped to the meta-ethnography and demonstrated that engaging communities can lead to improved outcomes for carers such as decreased fatigue or isolation, increase in size of caring networks and that wider social networks can influence factors such as place of death and involvement of palliative care services.


CONCLUSIONS
Evidence exists for the impact of community engagement in end-of-life care. Impact assessment should be an integral part of future initiatives and policy makers should recognise that these approaches can influence complex issues such as carer support, community capacity, wellbeing and social isolation.
St Joseph's Hospice, London, UK University of Edinburgh, Edinburgh, UK libbysallnow@gmail.com.
Libby
L
Sallnow
St Christopher's Hospice, London, UK.
Heather
H
Richardson
University of Edinburgh, Edinburgh, UK.
Scott A
SA
Murray
University of Bradford, Bradford, UK.
Allan
A
Kellehear
D003256:Community Participation; D006293:Health Promotion / Q000379:methods; D006801:Humans; D011634:Public Health; D012944:Social Support; D013727:Terminal Care / Q000379:methods / Q000458:organization & administration; D014838:Volunteers
Palliative care; community engagement; health promotion; impact; outcomes; public health