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Challenges and facilitators in delivering optimal care at the End of Life for older patients: a scoping review on the clinicians’ perspective


The concepts and elements determining quality of care at the End of Life may vary across professional groups but there is consensus that high-quality care at the End of Life is beneficial for the patient, families, health systems and society at large. This scoping review aimed to elucidate gaps in the delivery of this specific type of care in older people from the clinicians’ perspective, and to identify potential solutions to both improve this care and promote work satisfaction by the involved clinicians. Twelve studies published since 2010 with data from 18 countries identified four major gaps: (1) Core clinical competencies; (2) Shared decision-making; (3) Health care system, environmental context, and resources; and (4) Organisational leadership, culture and legislation. Multiple suggestions for staff communications training, multidisciplinary mentoring, and advance care planning alignment with patient wishes were identified. However, a clear picture arose of consistently unmet needs that have been previously highlighted in research for more than a decade. This indicates poor uptake of previous recommendations and highlights the difficulties in changing the service culture to ensure provision of optimal services at the End of Life. Future investigations on the reasons for poor uptake and identification of effective approaches to execute the agreed recommendations are warranted.

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Availability of data and materials

All data used for this review is presented in tables, figures or supplementary files. Further queries can be submitted to the corresponding author.


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We thank Dr. Abela Mahimbo for her qualitative advice in the early stages of this project, Nurse Kevin Heisner for his initial comments on an earlier version of the manuscript, the Bond University librarians for their response to our interlibrary loan requests, as well as Dr. Joanne Doran for proofreading an earlier version of the manuscript.


This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



MC and JC ran the initial search strategy. SF, CF, and MC independently screened titles and abstracts, and SF and CF then reviewed agreed full texts, with MC involved in resolving any discrepancies. SF and EP analysed the data. SG and DH provided valuable input with the manuscript. All the authors approved the final manuscript. Contributors who did not meet the criteria for authorship are listed in an “Acknowledgements”.

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Correspondence to Samantha Fien.

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MC previously developed and tested one of the tools used to determine article eligibility for this review. She derives no financial or other benefits whatsoever from its open access use in any setting. All the other authors declare no conflict of interest.

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This review does not contain any experiments involving human participants or animals performed by any of the authors.

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Fien, S., Plunkett, E., Fien, C. et al. Challenges and facilitators in delivering optimal care at the End of Life for older patients: a scoping review on the clinicians’ perspective. Aging Clin Exp Res 33, 2643–2656 (2021).

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  • Clinicians
  • End of Life
  • Quality of care