Collaboration and Coordination in Palliative Care. Palliative Care Networks in Switzerland

Project Logo
DOI of the original publication
URI
https://irf.fhnw.ch/handle/11654/30329
Project type
angewandte Forschung
Project start
01.06.2017
Project end
31.07.2020
Project status
abgeschlossen
Project contact
Liebig, Brigitte
Project manager
Liebig, Brigitte
Contributors
Degen, Eveline
Description
Abstract
In der Schweiz gibt es wenig gesichertes Wissen zum Funktionieren von palliativen Versorgungsnetzwerken. Die Studie will eine Übersicht über Umsetzungsmodelle sowie Richtlinien für die Zusammenarbeit und Koordination von Leistungserbringern im Bereich Palliative Care schaffen. Basierend auf bestehenden Daten und Dokumenten werden die Rahmenbedingungen von palliativen Versorgungsnetzwerken in vier unterschiedlich organisierten Kantonen der Schweiz analysiert. In diesen Kantonen werden zudem palliative Leistungserbringer interviewt, um förderliche und hinderliche Faktoren für die Zusammenarbeit und Koordination sowie deren Wirkungen auf Patientinnen und Patienten zu eruieren. Überdies wird eine schweizweite Befragung von palliativen Leistungserbringern durchgeführt. Nebst der Validierung der qualitativen Ergebnisse sollen lokale, regionale und überregionale Netzwerke und Best Practices identifiziert werden. Auf dieser Basis werden Empfehlungen zur Verbesserung der Zusammenarbeit in der Palliativversorgung sowie zu erfolgreichen Netzwerk-Modellen formuliert.
Link
http://www.nfp74.ch/de/projekte/sektor-uebergreifende-versorgung/projekt-liebig
Created during FHNW affiliation
Strategic action fields FHNW
School
Hochschule für Angewandte Psychologie
Institute
Institut für Kooperationsforschung und -entwicklung
Financed by
Schweizerischer Nationalfonds (SNF)
Project partner
PD Dr. Klaus Bally, Univ Basel
Prof. Dr. Elisabeth Zemp, Univ. Basel
Dr. Claudia Gamondi, Bellinzona
Contracting authority
Schweizerischer Nationalfonds (SNF)
SAP reference
Keywords
Kooperation
Koordination
Palliative Care
Schweiz
Subject (DDC)
300 - Sozialwissenschaften, Soziologie, Anthropologie
150 - Psychologie
610 - Medizin und Gesundheit
Publications
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Interprofessionelle Qualitätszirkel für die Palliativversorgung
(EMH Schweizerischer Ärzteverlag, 2021) Degen, Eveline; Liebig, Brigitte [in: Primary and Hospital Care]
Interprofessionelle Qualitätszirkel können Fachleute unterschiedlichster Disziplinen zusammenführen, um die Herausforderungen des beruflichen Alltags in der allgemeinen und spezialisierten Palliative Care gemeinsam zu bewältigen. Ein aktuelles Projekt im Rahmen des Nationalen Forschungsprogramms «Gesundheitsversorgung » (NFP 74) hat dazu in enger Kooperation mit Hausärztinnen und Hausärzten ein Konzept und eine Agenda entwickelt.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Comparing the Perspectives of Professionals and Relatives Toward the Quality of Palliative Care: A Qualitative Study
(LIDSEN, 2020) Reeves, Emily; Liebig, Brigitte; Degen, Eveline [in: OBM Integrative and Complementary Medicine]
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.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Care Coordination in Palliative Home Care: Who Plays the Key Role?
(Ubiquity Press, 2020) Reeves, Emily; Liebig, Brigitte; Schweighoffer, Reka [in: International Journal of Integrated Care]
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.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Organizational determinants of information transfer in palliative care teams: A structural equation modeling approach
(Public Library of Science, 03.06.2021) Schweighoffer, Reka; Blaese, Richard; Liebig, Brigitte [in: PLOS ONE]
Several organizational factors facilitate or hinder information transfer in palliative care teams. According to past research, organizational factors that reduce information transfer include the inconsistent use of shared electronic patient files, frequent changes of healthcare staff, a lack of opportunities for personal exchange, and a lack of evaluation of collaborative processes. Insufficient information sharing between professionals can negatively impact patient safety, whereas studies have shown that some organizational factors improve collaboration between professionals and thus contribute to improved patient outcomes. The main purpose of this study is thus to investigate whether, and if so how, organizational factors contribute to successful information exchange in palliative care teams in Switzerland, while also accounting for the different care contexts of primary and specialized palliative care. A nationwide survey was aimed at medical professionals working in palliative care. In total, 379 participants (mean age = 49.8 years, SD = 10.3) were included in this study. Two main outcome variables were examined: healthcare providers’ satisfaction with information transfer in their team and their overall satisfaction with communication in their team. Hypotheses were tested by employing structural equation modeling. Findings revealed that the strongest predictors for effective information transfer in palliative care teams were sufficient opportunities for face-to-face meetings and supervision alongside feedback tools to improve collaborative practices and the application of guidelines and standards for collaboration. Face-to-face meetings were an even greater contributor to information transfer in specialized settings, whereas sharing the same work-based values with colleagues was considered more important in primary settings. Results from this study contribute to the existing literature elucidating how information transfer is facilitated in the field of palliative care. If proposed measures are implemented, this could possibly improve patient outcomes in palliative care. Furthermore, the findings can be useful for healthcare organizations and associations to make more efficient resource allocation decisions with the aim to optimize information transfer within the workforce.
01A - Beitrag in wissenschaftlicher Zeitschrift
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Collaborative Networks in Primary and Specialized Palliative Care in Switzerland - Perspectives of Doctors and Nurses
(Bentham, 2020) Schweighoffer, Reka; Reeves, Emily; Liebig, Brigitte [in: The Open Public Health Journal]
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.
01A - Beitrag in wissenschaftlicher Zeitschrift