Imbalanced psychological care provision in non-hospice based palliative services across England: A nationwide, cross-sectional survey

Abstract<b>Objectives:</b> To map the provision of specialist psychological care in non-hospice palliative settings across England, identifying patterns, variations, and barriers to implementing best practices.<b>Methods:</b> A concurrent cross-sectional mixed-methods e-survey was conducted, targeting Specialist Psychological Professionals (SPPs) working in non-hospice palliative care settings across England. The survey included 45 items, both closed and open-ended, assessing service provision, staff roles, and confidence levels in delivering psychological care. Descriptive statistics were used for quantitative data, while content analysis was applied to open-text responses.<b>Results:</b> Nineteen complete responses were received, primarily from urban-based services. Most services had limited access to full-time SPPs, with an average Whole Time Equivalent (WTE) of 0.47. Access to psychological care varied, with 57% of services available exclusively to cancer patients. Training was linked to increased confidence in delivering psychological care, but significant gaps were reported in supervision and training for non-specialist staff. Barriers to care included fragmented IT systems, poor communication across care settings, and limited psychological resources.<b>Conclusions:</b> Specialist psychological care provision in non-hospice settings is inconsistent, with substantial barriers to delivering best practice. Findings highlight a need for better integration of psychological care and increased psychological resources, with dedicated SPPs, integrated IT systems, and comprehensive staff training to ensure equitable access to psychological support. Future research should assess the impact of enhanced system organisation and training on patient outcomes and service efficiency.