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Background: Globally, palliative care services do not meet demand. The World Health Organisation reports that 14% of people who need palliative care currently receive it. Moreover, the increase in chronic disease prevalence will result in the need for services to continue to grow. In Ireland, to help manage this demand, it is recommended that all physiotherapists should be able to deliver basic palliative care to patients diagnosed with life-limiting illnesses. Objective: To explore the competency and confidence levels of physiotherapists in the management of patients with life-limiting conditions. Methods: An anonymous, cross-sectional online questionnaire was designed and administered to physiotherapists working across various settings in Ireland. Results: There were 90 respondents (response rate = 4.2%). A significant majority (93%, n = 84) agreed that most patients with life-limiting conditions can participate in physiotherapy. Just over half (56%, n = 50) felt confident in their ability to prescribe exercise for this cohort. Less than one-third (29%, n = 26) felt that the role of physiotherapy in palliative care was understood by the multi-disciplinary team. The majority (76%, n = 68) did not agree that their undergraduate training prepared them for work in this area. The ability to access mentorship from specialist palliative care physiotherapists was deemed as a facilitator in providing patient care. Conclusion: This study highlights the demand for greater palliative care education, the need for a better understanding among the wider multi-disciplinary team so that patients receive timely access to physiotherapy, and the importance of establishing strong links between specialist physiotherapists and their generalist counterparts. [ABSTRACT FROM AUTHOR]

Background: Respite services provide a break in the caregiving relationship for people with dementia and their carers, however they are often under-used and service acceptability can be low. This study aims to understand key stakeholders' experiences of respite services for people with dementia, with a view to informing respite service development.Methods: A systematic search was conducted of the Pubmed/MedLine, Embase, Cinahl, PsychInfo, Scopus, Web of Science, and Cochrane databases (1980-2016, English) with fixed search terms relating to 'respite' and 'dementia', following PRISMA guidelines. Noblit and Hare's approach to meta-ethnography was employed. Key concepts were identified across the papers and reciprocal and refutational translation techniques were applied to primary studies; findings were synthesized into third order interpretations and finally, a 'line-of-argument' was developed.Results: In total 23 papers were reviewed, which described 20 independent samples across 12 countries. The views of 889 participants were synthesized (13 people with dementia, 690 carers, 44 'service providers', 52 frontline staff, 70 managers, 12 volunteers, six academic/policy-makers, and two independent consultants). Five key concepts were identified and outlined i.e. 1) the transition to service use 2) expanding organizational capacity 3) dementia care quality 4) building a collaborative care partnership and 5) dyad restoration. There was broad agreement around the key areas for service development across the range of stakeholders (flexible and responsive person-centred care, meaningful activity for people with dementia, enhanced client-service communication and informational support). However, there was clear divergence in stakeholder perspectives around the barriers to implementation of such developments. Organizational tension was evident between frontline staff and management in respite services, hindering the cultural change necessary to facilitate service development in line with dyad's needs and preferences.Conclusion: Respite services must surmount internal organizational barriers to change, and cultivate a collaborative solution-focused care culture, which acknowledges the centrality of the dyad and their care preferences. Future research should explore the development of alternative/modified community respite service models, which have greater capacity to be responsive to the needs of each individual dyad. The perspectives of people with dementia must be included in research in this area going forward.Trial Registration: PROSPERO Registration Number: CRD42016050191 . [ABSTRACT FROM AUTHOR]