• Karleen F Giannitrapani, Kendall Lin, Ladees Al Hafi, Bhagvat Maheta, and Sarina R Isenberg.
• Center for Innovation to Implementation (Ci2i) (K.F.G, K.L, B.M), VA Palo Alto Health Care System, Menlo Park, USA; Department of Primary Care and Population Health (K.F.G), Stanford University School of Medicine, Palo Alto, USA. Electronic address: karleen@stanford.edu.
• J Pain Symptom Manage. 2024 Oct 1; 68 (4): e235e253e235-e253.

ContextCodesign is a methodology that includes active collaboration between stakeholders in designing solutions and has been used in the development and implementation of palliative care (PC) interventions.ObjectivesTo synthesize the state of evidence for codesign in the development of PC interventions.MethodsWe searched PubMed, EMBASE, and CINAHL for peer-reviewed studies published after 1995 that reported evidence of codesigned interventions and outcomes in patients receiving palliative, hospice, or end-of-life care. We screened studies through independent and blinded dual review within Covidence and assessed study quality with the 2018 Mixed Methods Appraisal Tool. We narratively synthesized codesign duration, engagement approach, stakeholders involved, intervention designs, follow-ups, and outcomes, comparing among codesigns reporting meaningful improvement in outcomes. We created a best practice checklist which we used to evaluate codesign use in each study.ResultsAbout 1,036 abstracts and 54 full text articles were screened. Twenty-eight studies met inclusion criteria and were abstracted. Feedback collection modalities ranged from iterative drafting, pilot testing, advisory panels, workshops, focus groups, and interviews. Thirteen studies applied pretesting/prototyping through pretest post-test, focus groups, prototypes, alpha and beta testing, and mock-ups. Eleven studies reported improved outcomes, eight of which utilized iterative codesign. All the studies reporting improved outcomes mentioned meeting with stakeholders at least twice. Two studies met all criteria in our codesign best practice checklist.ConclusionCodesigned PC interventions demonstrate high variance in the modality of acquiring feedback and application of codesign. Successful codesign leading to improvement in outcomes is achieved by involving patients, caregivers, and providers in iterating intervention design.Published by Elsevier Inc.

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