Understanding the implementation of kidney supportive care interventions to improve palliative care outcomes for adults receiving haemodialysis: protocol for a rapid realist review.

introductionChronic kidney disease (CKD) is a significant global health concern, contributing substantially to mortality; in advanced stages, adults often require kidney supportive care (KSC), a model of care/intervention that addresses complex palliative and supportive needs. These needs often remain insufficiently addressed, particularly among adults receiving haemodialysis, due to the interplay of multiple contextual factors and inconsistent reported outcomes. Consequently, it remains unclear how, for whom and under what circumstances KSC works (or does not work). Therefore, this rapid realist review aims to identify the key contexts in which KSC interventions have been implemented and the mechanisms that influenced palliative care outcomes for adults receiving haemodialysis. METHODS AND ANALYSIS: Rapid realist review is a structured, theory-driven approach to evidence synthesis conducted within a condensed timeframe, aiming to explain how and why interventions work, for whom and in what contexts, to identify effective models of service delivery. This rapid realist review will be conducted following a multiple-step process, including defining the project scope and research questions development (including how the findings will be utilised); development of search terms and identification of relevant literature; quality appraisal; data extraction and preliminary programme theory development; validation and refinement of programme theory with content experts; and dissemination of findings.A systematic literature search will be conducted from 2020 to 2025 using the following databases: MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Scopus and Academic Search Complete, with supplementary forward and backward citation tracking. Two reviewers will screen titles and abstracts for relevant research, and the full papers selected will be used to extract data and assess the quality of evidence based on relevance, richness and rigour. Data extraction and synthesis will be conducted iteratively to identify context-mechanism-outcome configurations (CMOCs), which will inform the development and refinement of the programme theory, rather than simply informing palliative care outcomes.A 10-member expert panel will review, evaluate and reflect on the initial CMOCs in light of their clinical expertise and personal experience. The reporting of findings from this review will be guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES). This rapid realist review will support service redesign to better address the unmet palliative care needs of adults receiving haemodialysis and inform policy initiatives and education to deliver context-specific KSC across the UK and globally. ETHICS AND DISSEMINATION: This study received ethics approval from Coventry University Ethics Committee (Ref-P182536). Results will be disseminated to stakeholder groups and by means of publication in a peer-reviewed journal and presentation at international scientific conferences. PROSPERO REVIEW REGISTRATION: CRD420251000111.