对临终关怀服务的获取存在差异性，很多住院患者没有接受到临终关怀。概述可能的障碍可以促进制定克服影响临终关怀需求患者获取服务的策略的发展。对妨碍成年住院患者获取临终关怀的障碍的当前证据进行回顾。使用综合相交法和主题综合进行了混合方法系统评价（PROSPERO ID：CRD42021279477）。从2003年10月到2020年12月，检索了Cochrane图书馆、MEDLINE、CINAHL和PsycINFO。满足以下条件并进行审核的研究包括具有关于住院患者获取现有临终关怀服务障碍证据的研究。经过初步筛选3359份记录和555篇全文，包括了79个研究。主题综合总结了6个主要类别中的149个与获取相关的现象：（1）社会人口统计特征，（2）与健康相关的特征，（3）个体信仰和态度，（4）人际合作与支持，（5）资源的可用性和分配，以及（6）临终关怀的特殊挑战。虽然对大多数社会人口统计特征因素的证据不一致，但以下障碍出现：非癌症情况或低症状负担，医院着重于治愈，对临终预后不接受，对临终关怀的负面认知，误导性沟通和冲突的关怀偏好，资源匮乏，协调不足，专业知识不足，临床医生的情感不适和预后困难。住院患者面临多重障碍以获取临终关怀。解决这些障碍的策略需要考虑到它们的多维性和长期存在。版权所有©2023 Elsevier Inc.发表

Access to palliative care services is variable, and many inpatients do not receive palliative care. An overview of potential barriers could facilitate the development of strategies to overcome factors that impede access for patients with palliative care needs.To review the current evidence on barriers that impair, delay, or prohibit access to palliative care for adult hospital inpatients.A mixed methods systematic review was conducted using an integrated convergent approach and thematic synthesis (PROSPERO ID: CRD42021279477).The Cochrane Library, MEDLINE, CINAHL, and PsycINFO were searched from 10/2003 to 12/2020. Studies with evidence of barriers for inpatients to access existing palliative care services were eligible and reviewed.After an initial screening of 3,359 records and 555 full-texts, 79 studies were included. Thematic synthesis yielded 149 access-related phenomena in 6 main categories: (1) Sociodemographic characteristics, (2) Health-related characteristics, (3) Individual beliefs and attitudes, (4) Inter-individual cooperation and support, (5) Availability and allocation of resources, and (6) Palliative care-specific challenges. While evidence was inconclusive for most socio-demographic factors, the following barriers emerged: having a non-cancer condition or a low symptom burden, the focus on cure in hospitals, non-acceptance of terminal prognosis, negative perceptions of palliative care, misleading communication and conflicting care preferences, lack of resources, poor coordination, insufficient expertise, and clinicians' emotional discomfort and difficult prognostication.Hospital inpatients face multiple barriers to accessing palliative care. Strategies to address these barriers need to take into account their multidimensionality and long-standing persistence.Copyright © 2023. Published by Elsevier Inc.