Understanding workplace peer support among healthcare assistants providing palliative and end-of-life care at home: a realist review

Background: Healthcare assistants delivering home-based palliative and end-of-life care face complex emotional and clinical demands with limited workplace support. Peer support had been suggested as a potential solution, yet no reviews of such interventions exist. Aim: To understand and explain how, why, for whom and in what contexts workplace peer support interventions for healthcare assistants work (or do not work) in palliative and end-of-life care delivery at home. Design: Realist review registered with PROSPERO (registration number CRD42024606133). Data sources: CINAHL, MEDLINE, AMED, Scopus and grey literature with no date restrictions. Searches undertaken November-December 2024. All study designs containing data relevant to programme theory were included. Evidence was assessed for relevance, trustworthiness and rigour. Results: Synthesis of 24 sources from six countries generated 12 context-intervention-mechanism-outcome configurations used to develop initial programme theory. Four workforce outcomes of intervention include: enhanced wellbeing and resilience, reduced loneliness and isolation, development of a sense of community of practice and strengthened role identity. Three intervention strategies: peer-facilitated group meetings, 24/7 peer support access, and informal peer mentorship, create psychologically safe spaces, where individuals feel validated, valued, connected with others, enabling social learning. The intervention elements align with the fulfilment of three basic psychological needs: competence, autonomy, and relatedness. Conclusions: The initial programme theory reveals peer support may address core workforce challenges through psychologically safe peer connections and social learning, aligning with fulfilment of basic psychological needs. It provides a foundation for designing and testing evidence-informed peer support interventions for this workforce.