title: Conceptual foundations of a palliative approach: a knowledge synthesis.
abstract: BACKGROUND
  Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A "palliative approach" has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity.
  
  
  METHODS
  We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to "palliative care" and "chronic life-limiting conditions" were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach.
  
  
  RESULTS
  The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care.
  
  
  CONCLUSIONS
  Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
authors.affiliation: School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada. Rick.Sawatzky@twu.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: Sawatzky
authors.affiliation: School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada.
authors.forename: Pat
authors.initials: P
authors.lastname: Porterfield
authors.affiliation: School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Lee
authors.affiliation: School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
authors.forename: Duncan
authors.initials: D
authors.lastname: Dixon
authors.affiliation: School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lounsbury
authors.affiliation: School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pesut
authors.affiliation: Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada.
authors.forename: Della
authors.initials: D
authors.lastname: Roberts
authors.affiliation: Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Tayler
authors.affiliation: Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Voth
authors.affiliation: School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
authors.forename: Kelli
authors.initials: K
authors.lastname: Stajduhar
mesh_terms: D032722:Advance Care Planning / Q000706:statistics & numerical data; D006801:Humans; D019359:Knowledge; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D012944:Social Support; D066252:Sociological Factors