Developing a framework for primary palliative care services

Abstract

Practice and empirical data indicate concerns regarding the delivery of primary palliative care, particularly the provision of a multidisciplinary approach. A collaborative study was undertaken between an academic unit and primary care practice to evaluate current care provision and explore methods of developing services. A two-phase study was carried out over a period of 18 months using an action research approach, in order to facilitate concurrent service evaluation, change in practice, and the involvement of professionals in research and practice development. The first phase highlighted the need to enhance primary palliative care services; a number of practice changes were identified and implemented during the second phase and evaluated using quantitative and qualitative methods. Data demonstrated the enhancement of services, benefits to patient care and professional working and the viability of an innovative model of palliative care delivery - that of a surgery-based clinic for palliative care patients and carers. A framework for the provision of multidisciplinary palliative care in the community was developed.

Non-specialist palliative care: A principle-based concept analysis

“…8,[59][60][61] This term has, in particular, contributed to ambiguity in definition and might be somewhat misleading. This is because some authors view primary palliative care as palliative care (either specialist or non-specialist) that is delivered specifically in the community setting [62][63][64][65][66][67] and as such is not specific to non-specialist palliative care. Table 2 provides examples of the broad and varied terms used to define non-specialist palliative care within and between countries.…”

“…These include communication skills, 52,72,[83][84][85] psychological and spiritual care, 22,25,52,86,87 family/carer support and psychosocial support. 65,[88][89][90] These attributes of non-specialist palliative care (Table 4) were also consistently identified in attempts to operationalise non-specialist palliative care for clinicians through palliative care competency documents in regions such as Ireland, Africa, Scotland, Northern Ireland and Australia and were present within all levels of palliative care competency (both specialist and non-specialist). Furthermore, the attributes included in Table 4 are also identified as components of educational interventions in studies on non-specialist palliative care 66,84 and were also used as indicators to address palliative care competence among generalist palliative care providers.…”