TY  - JOUR
T1  - Interprofessional Handover and Continuity of Care between Hospital and Community Palliative Services
A1  - Aisha Rahman
A1  - Kwame Boateng
A1  - Naledi Mokoena
A1  - Li Wei
JF  - Journal of Integrative Nursing and Palliative Care
JO  - J Integr Nurs Palliat Care
SN  - 3006-5550
Y1  - 2026
VL  - 7
IS  - 1
DO  - 10.51847/1svAiWcQqP
SP  - 247
EP  - 258
N2  - Transitions from hospital to community palliative services expose patients and families to a distinctive continuity problem. Clinical information may be transferred while responsibility, follow-through, relational knowledge, and mechanisms for resolving uncertainty remain fragmented. This conceptual article develops a cross-setting continuity framework for examining that problem. It integrates informational, management, and relational continuity with clinical handover content, accountability transfer, interprofessional communication, patient and family participation, and feedback between hospital and community services. The central argument is that continuity after discharge depends on whether clinically relevant information becomes interpretable and actionable within a receiving system that has accepted responsibility and can respond when needs change. The framework therefore distinguishes transmission from receipt, receipt from enactment, and planned home care from the adaptive escalation that may become appropriate as illness, caregiver capacity, or preferences change. This approach provides a basis for analysing transition failures without treating every hospital return as evidence of failed care. It also identifies testable service-design and evaluation questions for cross-setting palliative practice.
UR  - https://journalinpc.com/article/interprofessional-handover-and-continuity-of-care-between-hospital-and-community-palliative-services-xinwtmi02gvvfjg
ER  -