TY - JOUR

T1 - Judgements about fellow professionals and the management of patients receiving palliative care in primary care

T2 - a qualitative study

AU - Walshe, Catherine

AU - Todd, Chris

AU - Caress, Ann

AU - Chew-Graham, Carolyn

PY - 2008/4/1

Y1 - 2008/4/1

N2 - BackgroundPolicies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services.AimTo explore the influences on referrals within general and specialist community palliative care services.Design of studyQualitative, multiple-case study.SettingThree primary care trusts in the north-west of England.MethodMultiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals.ResultsJudgements — positive and negative — about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional `game playing' to achieve professionals' desired outcomes.ConclusionPalliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.

AB - BackgroundPolicies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services.AimTo explore the influences on referrals within general and specialist community palliative care services.Design of studyQualitative, multiple-case study.SettingThree primary care trusts in the north-west of England.MethodMultiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals.ResultsJudgements — positive and negative — about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional `game playing' to achieve professionals' desired outcomes.ConclusionPalliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.

KW - case study

KW - interprofessional care

KW - palliative care

KW - primary health care

KW - qualitative research

UR - http://www.scopus.com/inward/record.url?scp=42049095680&partnerID=8YFLogxK

U2 - 10.3399/bjgp08X279652

DO - 10.3399/bjgp08X279652

M3 - Journal article

AN - SCOPUS:42049095680

VL - 58

SP - 264

EP - 272

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 0960-1643

IS - 549

ER -