TY - JOUR

T1 - Integrated palliative care is about professional networking rather than standardisation of care

T2 - A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries

AU - den Herder-van der Eerden, Marlieke

AU - van Wijngaarden, Jeroen

AU - Payne, Sheila

AU - Preston, Nancy

AU - Linge-Dahl, Lisa

AU - Radbruch, Lukas

AU - Van Beek, Karen

AU - Menten, Johan

AU - Busa, Csilla

AU - Csikos, Agnes

AU - Vissers, Kris

AU - van Gurp, Jelle

AU - Hasselaar, Jeroen

PY - 2018/2/13

Y1 - 2018/2/13

N2 - BACKGROUND: Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking.AIM: To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe.DESIGN: Qualitative group interview design.SETTING/PARTICIPANTS: A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%).RESULTS: The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services.CONCLUSION: Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

AB - BACKGROUND: Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking.AIM: To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe.DESIGN: Qualitative group interview design.SETTING/PARTICIPANTS: A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%).RESULTS: The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services.CONCLUSION: Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

KW - Delivery of healthcare

KW - integrated

KW - inter-professional relations

KW - qualitative research

KW - palliative care

U2 - 10.1177/0269216318758194

DO - 10.1177/0269216318758194

M3 - Journal article

C2 - 29436279

JO - Palliative Medicine

JF - Palliative Medicine

SN - 0269-2163

ER -