Understanding Palliative Care Provision for People with Multiple Long‑Term Conditions (MLTC) and/or Frailty; A Protocol for a Realist Evaluation

Introduction People living with multiple long-term conditions (MLTC) and/or frailty represent a rapidly growing and underserved population, who experience fragmented and crisis driven care, particularly towards the end of life. Despite international policy highlighting that access to palliative care should be based upon need rather than diagnosis, conventional service models are organised around single (mostly malignant) conditions and do not adequately address the cumulative complexity and functional decline associated with MLTC. Aim This protocol describes a realist evaluation to explain what works, for whom, in what contexts, through which mechanisms, and why, in relation to palliative care provision for people with MLTC and/or frailty. Methods and analysis Underpinned by critical realism and informed by RAMESES II standards, this realist evaluation forms part of the multi-phase Palliative caRe needs Of people with Multiple long term conditIonS Establishing recommendations for service innovation (PROMISE) research programme. PROMISE developed an Initial Programme Theory (IPT) and candidate Context–Mechanism–Outcome Configurations (CMOCs) drawing on evidence synthesis and qualitative work, including 27 interviews with health and social care professionals across England. The current phase will analyse data from five multidisciplinary focus groups (n = 74) conducted during a regional stakeholder conference in North East England and North Cumbria. Using iterative retroductive analysis, candidate CMOCs will be refined, rejected or replaced, and additional CMOCs will be developed to strengthen and refine the IPT. Study status Data collection was completed prior to protocol submission; no formal analysis has commenced. This protocol outlines how data will be analysed. Ethics and dissemination Ethical approval has been granted by the UK Health Research Authority and Health and Care Research Wales (IRAS 348092; REC 24/PR/1085). Dissemination will include peer-reviewed publications, an Oxford University MSc in Evidence-Based Health Care dissertation, policy-facing outputs facilitated through involvement in the Policy Research Unit for Healthy Ageing, and co-produced open-access resources for people living with MLTC and/or frailty and their families.