BackgroundComplex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care.MethodsSemi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings.ResultsThe interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care.ConclusionsComplexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life.Electronic supplementary materialThe online version of this article (10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
People with disabilities in Moldova experience negative cultural attitudes linked to an outdated conception of disability itself. There are inadequate community support services and infrastructure which act as barriers to inclusion. At present, there can be limited interaction and participation of people with disabilities within local communities, and so few opportunities to refute persistent stereotypes and stigma surrounding disability.
Introduction Complex needs for palliative care patients are not well defined, yet clarity is necessary to meet the needs of patients and their families in all settings, round the clock. Aim To explore professionals' understandings of patient complexity in palliative care across 3 settings. Methods We triangulated the findings from 3 qualitative studies. Semi-structured interviews were conducted with professionals from primary, specialist palliative and acute care. Interviews were audio-recorded, transcribed, coded thematically and analysed by each study researcher, independently. Emerging themes were then discussed as a team and a framework was devised to comprehensively collate, compare and contrast all three sets of results. Results Thirty-four interviews were conducted across the 3 settings. A number of themes spanned all three settings. The interaction between diverse physical, psychosocial and spiritual needs, existing co-morbidities, intractable symptoms and complicated social issues exacerbated patient complexity, particularly for primary care professionals 'out of hours'. Poor communication was highlighted, particularly between generalists and specialists, although primary care professionals highlighted the potential of electronic care summaries. Generalists felt they lacked skill in identifying and caring for complex patients and time for professional development in palliative care. Conclusion Patient complexity is influenced by patient factors but also environmental factors, specific to each setting. Better communication between disciplines could improve the care of patients outside normal working hours. A clear definition of complexity will improve the identification of patients for specialist palliative care, which has implications for resource allocation across all settings. REFERENCES
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