2020, Schweighoffer, Reka, Reeves, Emily, Liebig, Brigitte

To date, information about collaborative networks of doctors and nurses in palliative care is still scarce, yet of great importance in revealing gaps in collaboration. This paper investigates the collaboration frequencies of medical doctors and nurses within, and across, different settings of palliative care. The study was based on a Swiss national survey on “Collaboration and cooperation in Palliative Care”. The subjects surveyed included service providers in the primary and specialized palliative care sectors, as well as support services (N=1111). Information about ties between providers was gathered by asking professionals to estimate the frequency of interaction with other professionals within the last year, on a daily, weekly, monthly and yearly basis. Social network analysis was used to assess the interaction patterns of nurses and doctors (N= 728) in primary and specialized care settings. Visual representations indicated that, contrary to primary care settings, healthcare providers in specialized care settings reported of numerous interactions with other professions. In primary care, general practitioners reported the least frequent interactions with other professions. Of all providers investigated, specialized doctors in hospitals and hospices reported the densest collaborative networks. Gaps regarding collaboration in Swiss palliative care provision were revealed. Based on the results of the study, recommendations on how to improve service quality by strengthening the interaction patterns of general practitioners, as well as community-based palliative care, are provided.

2020, Reeves, Emily, Liebig, Brigitte, Schweighoffer, Reka

Background: Clearly identified professionals who are appointed for care coordination are invaluable for ensuring efficient coordination of health care services. However, challenges to identifying roles in palliative care are well documented in literature. Notably, in order to meet high demands on palliative home care settings, many care practitioners perform tasks that surpass the responsibilities and regulations of their role, including care coordination. Without clearly defined roles, standards of care cannot be guaranteed. Yet, little is understood about who plays the key role in palliative home care. Aim: The present study aims to address the gap in the research by identifying who plays a key role in coordination in palliative home care. Methods: Interviews with general practitioners (GPs), nurses and relatives of palliative patients were carried out in Swiss cantons (Vaud, Ticino, Luzern and Basel) to identify key coordinators of care. Interviews were analyzed using content analysis and presented using grounded theory. Results: Findings indicated that there was considerable ambiguity of the key coordinator role. 1) Causal conditions of this phenomenon were; informality of professional roles and lack of communication between team members, 2) Consequences of this included; conflicting understandings of key coordinator role and family members feeling overburdened, 3) Strategies adopted by interviewees included; adapting or taking control of care coordination. These findings are highly indicative of areas for improvement for care coordination in palliative home care settings. Specifically, they underline a profound need for clear communication between palliative care service providers regarding which professionals assume a key coordative role, or who are delegated a coordinative role at any given time. Crucially, since the findings reveal that relatives are intimately involved in care coordination, the findings point to a lack of adequate financial and psycho-social support for relatives of palliative patients who are burdened with coordination tasks, without the appropriate recompense.

2020, Reeves, Emily, Liebig, Brigitte, Degen, Eveline

High-quality care is an important aim of palliative care services. However, the quality of care is a complex phenomenon and is subjectively perceived by those who are closest to the services and are often evaluated poorly. Prior research has highlighted the difficulties in evaluating the quality of care because of different perspectives, and still, only a little is understood about the perception of the quality of care in palliative care services. Investigating the perspectives of key individuals involved in palliative care, such as palliative professionals and relatives of palliative patients, can provide invaluable insight to understand the quality of care. To identify the perceptions of palliative professionals and relatives of the patients toward the quality of palliative care along with identifying the similarities and divergences in the perceptions, as well as highlighting the complexity of quality in palliative care settings while indicating their areas of improvement. This was a qualitative study that involved semi-structured interviews for the evaluation of palliative care guided by the proposed system approach model [1]. The interviews were conducted with a total number of 38 professionals working in palliative care along with 26 relatives of palliative patients across four Swiss cantons (Ticino, Basel, Vaud, and Lucerne). These professionals worked in primary palliative care (PPC) and specialized palliative care (SPC), where 11 general practitioners (GP’s) and 12 nurses were from primary palliative care services. Additionally, 15 interviews were conducted with 9 specialized medical doctors (e.g., oncologists) and 6 specialized palliative care nurses from different hospitals, hospices, mobile palliative care teams (MPCT’s), and specialist private practice. The results revealed considerable differences between the perspectives of professionals and relatives regarding the following aspects of care: 1) the availability, 2) client-centeredness (including respect for patient’s wishes and relative’s involvement in care, 3) satisfaction (including physical and psychosocial), and 4) communication and information transfer. Mainly, the family members felt that care was not being always readily available and coordinated poorly, the patient’s needs were overlooked because of the lack of time. Also, some professionals were perceived to be incompetent with a lack of communication and negligence toward the psychosocial needs of the patient. On the other hand, professionals indicated that relatives may be too involved in the patient care and might have expressed concern due to the high risk of burn out caused by extreme stress and emotionally taxing circumstances of palliative care. The different perspectives uncovered both the similarities and discrepancies, representing a demand for addressing the shortcomings of palliative care services. Specifically, findings indicated that professionals may overestimate the quality of palliative care. Also, future initiatives were needed to ensure that the family members of palliative patients were adequately supported, both psycho-socially and financially, justifying the investment. These findings would help in informing the health policy about the aspects of care that require specific attention to improve the overall quality of care and urge future research to explore the best ways to support these aspects of care.

2020, Reeves, Emily, Schweighoffer, Reka, Liebig, Brigitte

Good coordination of healthcare services is vital for ensuring health cost efficiency and high-quality care for patients. It is especially important in the context of palliative care as services are often highly fragmented due to a combination of diverse professional groups, organizations, and approaches to care. However, the coordination of services in this field is often evaluated as insufficient. Little is known about the challenges to coordination in this sector in Switzerland. The present study addresses this gap in research by investigating the challenges to coordination at the interface of palliative care services in Switzerland. Interviews (n = 24) with 38 healthcare practitioners working in palliative care in four cantons (Basel-City, Lucerne, Ticino, and Vaud) form the basis for this investigation. The selected cantons not only represent French, Italian, and German language regions of Switzerland but also represent diverse rural, urban, and historical contexts. Expert interviews are analyzed using structural content analysis. Three clusters of challenges to coordination were identified in the data: (1) organizational challenges to coordination, which relate to explicit forms of coordination; (2) relational challenges to coordination; and (3) structural challenges to coordination, which relate to implicit forms of coordination. The study reveals a need for better financial support for coordination in palliative care and a stronger focus on interprofessional coordination in educating professionals in palliative care. Future research on how to further foster good team coordination practices between primary and specialized palliative services merits further investigation. Since these findings are indicative of areas for improvement for coordination at the interface of Swiss palliative care services, they are of particular interest for healthcare practitioners, policymakers, and researchers involved in the evolution of coordinative practice.