OP-1 Workplace peer support among healthcare assistants providing palliative and end-of-life care at home: a realist review

Introduction Hospice managers recognise that healthcare assistants delivering palliative care at home require robust workplace support to manage the unique demands of their role. Healthcare assistants work predominantly alone, managing complex emotional and clinical demands. They sometimes feel undervalued, experience inconsistent support, yet remain motivated to provide excellent care. They identify peer connections as crucial for processing difficult experiences and developing confidence in their role. However, evidence is lacking on what peer support approaches work in practice. Aims 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 home-based palliative and end-of-life care. Methods Realist review following established framework(1) and standards(2), synthesising evidence on workplace peer support across multiple databases and grey literature sources without date restrictions. Results Synthesis of 24 sources from six countries identified three intervention strategies: peer-facilitated group meetings (regular, providing structured reflection time), 24/7 peer support access (telephone or messaging for real-time support), and informal peer mentorship (pairing experienced and newer staff). The outcomes of such support are improved staff wellbeing, reduced isolation, strengthened professional identity, and development of a sense of community of practice when specific conditions are present. These conditions include trained peer facilitators with shared experience, integration within existing professional development frameworks and organisational endorsement positioning peer support as valued practice. Success depends on creating psychologically safe spaces where staff feel validated and connected, enabling social learning among peers. Without supportive organisational context and trained facilitators, these interventions may not achieve desired outcomes. Conclusion: Workplace peer support represents an evidence-based intervention for addressing healthcare assistant workforce challenges. Impact Our findings provide hospice leaders a foundation for designing peer support programs addressing the challenges of emotional labour and professional isolation, with potential to improve staff retention and care quality. References Pawson R. Realist synthesis: new protocols for systematic review. In: Evidence-based policy: a realist perspective. London: SAGE Publications Ltd, 2006. p. 73–104. Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. RAMESES publication standards: realist syntheses. J Adv Nurs. 2013;69(5):1005–22.