title: Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers.
abstract: OBJECTIVE
  To understand patients and family caregivers' experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users.
  
  
  METHODS
  We performed a meta-ethnography of qualitative evidence following PRISMA recommendations for reporting systematic reviews. The studies were retrieved in 5 electronic databases (MEDLINE, EMBASE, PsycInfo, BNI, CINAHL) using 3 terms and its equivalents ('Palliative', 'Home care', 'Qualitative research') combined with 'AND', complemented with other search strategies. We included original qualitative studies exploring experiences of adult patients and/or their family caregivers (≥18 years) facing life-limiting diseases with palliative care needs, being cared for at home by specialist or intermediate home palliative care services.
  
  
  RESULTS
  28 papers reporting 19 studies were included, with 814 participants. Of these, 765 were family caregivers and 90% were affected by advanced cancer. According to participants' accounts, there are 2 overarching components of home palliative care: presence (24/7 availability and home visits) and competence (effective symptom control and skilful communication), contributing to meet the core need for security. Feeling secure is central to the benefits experienced with each component, allowing patients and family caregivers to focus on the dual process of living life and preparing death at home.
  
  
  CONCLUSIONS
  Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care.
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.|Department of Medicine, Hospital do Espírito Santo de Évora, Évora, Portugal.
authors.forename: Vera P
authors.initials: VP
authors.lastname: Sarmento
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.|Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Gysels
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, Cicely Saunders Institute, London, UK.|Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
mesh_terms: D000884:Anthropology, Cultural; D017028:Caregivers; D006699:Home Care Services; D006801:Humans; D010166:Palliative Care; D057240:Patient Preference; D010361:Patients
keywords: Home care services; Hospice care; Palliative Care; Patient preference; Qualitative research