Common care practices among effective community-based specialist palliative care teams: a qualitative study

Abstract

ObjectiveEvidence has shown that, despite wide variation in models of care, community-based specialist palliative care teams can improve outcomes and reduce acute care use at end of life. The goal of this study was to explore similarities in care practices among effective and diverse specialist teams to inform the development of other community-based teams.MethodsInterviews with 78 providers and administrators from 11 distinct community-based specialist palliative care teams from Ontario, Canada were conducted. Interviews were audio-recorded, transcribed and analysed using an inductive approach to identify common themes.Results3 key themes across all teams emerged. First, the distinct models of care were generally summarised into 3 models: primary care and specialist providers either collaborated by transferring, sharing or consulting in care. Second, teams explicitly or implicitly followed 7 common care practices related to: specialised expertise 24/7; intrateam communication; timeliness; physical symptom and psychosocial–spiritual management; education; peace and fulfilment; and advocacy for patient preferences. Third, all teams emphasised the importance of team building, even more than using clinical tools and processes.ConclusionsDespite wide variation in models of care among community-based specialist palliative care teams, this large qualitative study identified several common themes in care practices that can guide the development of other teams.

A Review of the Essential Components of Quality Palliative Care in the Home

“…Although the real-life examples examined in this review shared many common care principles, no two programs were identical. 28,33 Rather, each model reflects local community partnerships, culture, and assets. Obtaining integration of community-based services is a challenge, particularly in palliative care where multiple providers and organizations may be involved.…”

“…43 A demonstrated approach to achieving the essential elements proposed is to start small and build on local strengths. 33,44,45 Evidence shows that a top-down, one-size-fits-all approach often fails in implementing and sustaining quality palliative care programs. 33,46 Recommendations cannot be too rigid in terms of structures and processes.…”

“…33,44,45 Evidence shows that a top-down, one-size-fits-all approach often fails in implementing and sustaining quality palliative care programs. 33,46 Recommendations cannot be too rigid in terms of structures and processes. The essential elements of quality palliative care as indicated should be standardized, but how to achieve them should be flexible.…”

“…This study involved in-depth in-person interviews with 78 providers and administrators from 11 distinct communitybased specialist palliative care teams from Ontario, Canada. 33 The teams care for patients in their homes, working in conjunction with standard homecare. In a prior study, care from these specialist palliative care teams was found to be associated with a 50% reduction in late-life hospital use and hospital death, compared with usual community care.…”

Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study

“…In Ontario, regions have independently developed their own community-based specialist palliative care teams to improve palliative care access and delivery over time. 20 These teams vary in terms of the geographic area they serve, patient admissions (range 90-830 patient deaths over 2 yr) and team size (3 to 18 full-time equivalent [FTE] positions) ( Table 1). The mean time from admission to a specialist palliative care team to death was 73 days.…”