18 PROMISE: palliative care needs of people with multiple long-term conditions: Establishing recommendations for service innovation

<h3>Background</h3> Most people live with and die from multiple long-term conditions (multimorbidity) (MLTC-M). People living with MLTC-M have high healthcare use in the last year of life. They are also less likely to receive palliative care. Understanding how to provide better care for this group is key to addressing inequitable access, as MLTC-M is a common feature across populations experiencing health inequity. <h3>Aim</h3> To understand decision-makers’ perspectives on service design to meet the palliative care needs of people with MLTC-M and their families. <h3>Design</h3> Semi-structured qualitative interviews, analysed using Framework Analysis. <h3>Participants/setting</h3> Interviews were conducted with senior decision-makers and professionals in health and social care across England, using a case study approach. Participants were purposively selected for their oversight of services, ensuring representation from a range of expertise, professions, and settings. To date, 16 interviews have been conducted and recruitment is ongoing. <h3>Results</h3> Adapting Bronfenbrenner’s Ecological Systems Theory as a framework, themes were categorised into five interrelated systems around individuals with MLTC-M. Within the microsystem (individual needs/characteristics), participants identified challenges recognising those entering the palliative phase. In the mesosystem (interactions with family, professionals, and healthcare settings), care was described as disjointed, depersonalised, and characterised by reactive emergency responses. In the exosystem (healthcare services), participants observed difficulty navigating systems built around single-organ specialisms, lack of integration between primary and secondary care and resource constraints. For the macrosystem (societal/cultural influences), participants called for a public health approach to improving death literacy across communities. Finally, the chronosystem underscored the importance of addressing changing needs over time, emphasizing timely, individualised advance care planning. Multi-disciplinary holistic assessment and creation of community-based ‘Key Workers’ to guide access to services were suggested. <h3>Conclusion</h3> People living and dying with MLTC-M are inadequately supported by current care models. This study highlights areas of unmet need and suggestions for innovation.