Enhancing integrated palliative care: what models are appropriate? A cross-case analysis

Abstract

BackgroundEffective integration between hospices, palliative care services and other local health care services to support patients with palliative care needs is an important international priority. A previous model suggests that integration involves a cumulative stepped process of engagement with other organisations labelled as ‘support, supplant or supplement’, but the extent to which this model currently applies in the United Kingdom is unknown. We aimed to investigate accounts of hospice integration with local health care providers, using the framework provided by the model, to determine how service users and healthcare professionals perceived palliative care services and the extent of integration experienced.MethodsLongitudinal organisational case study methods were employed using qualitative serial interviews (interval 3 months) with patients and family carers focusing on how services responded to their needs; and group interviews with health professionals. Data were audio-recorded, transcribed verbatim, and analysed by qualitative content analysis and combined across data sources.ResultsThe study focused on four hospices in northern England, including 34 patients (diagnosis: 17 cancer, 10 COPD, 7 heart failure), 65% female, mean age 66 (range 44–89), 13 family carers of these patients (48% partners), and 23 health care professionals. While some care fell short of expectations, all patients reported high levels of satisfaction and valued continuity of care and efficient information sharing. All hospices supported and supplemented local providers, with three hospices also supplanting local provision by providing in-patient facilities.ConclusionUK hospices predominantly operate in ways that support and supplement other providers. In addition, some also supplant local services, taking over direct responsibility and funding in-patient care. They all contributed to integration with local services, with greater blurring of boundaries than defined by the original model. Integrated care offers the necessary flexibility to respond to changes in patient needs, however, constraints from funding drivers and a lack of clear responsibilities in the UK can result in shortfalls in optimal service delivery. Integrating hospice care with local healthcare services can help to address demographic changes, predominantly more frail older people, and disease factors, including the needs of those with non-malignant conditions. This model, tested in the UK, could serve as an example for other countries.

Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review

“…This was sometimes described as a result of delayed or irregular medical reviews with specialists, or the lack of coordinated approach to care. This had a negative impact on both patients and carers 51 52…”

<p>Describing Complexity in Palliative Home Care Through HexCom: A Cross-Sectional, Multicenter Study</p>

“…Specifically, in the case of patients with cancer or organ failure, quick access to palliative care beds must be available and preferences regarding place of death must be taken into consideration. Our results also show that the role of the social worker on these teams and their integration in the social and community network must be reinforced [57][58][59][60][61][62][63] and that, due to the intensity of this type of care (refractoriness, changing circumstances and short duration), health-care teams and professionals must be encouraged to practice self-care. [64][65][66][67][68] These findings highlight the importance of the presence of a skilled caregiver in the home, as well as the need for assessment of all areas included in the model due to the heavy burden that the psychosocial field can have on suffering at the end-of-life.…”

Türkiye’de ve Dünya’da palyatif bakım modellerine genel bakış

“…20.yüzyılın son çeyreğinde dünyada palyatif bakım ve hospis bakımı ile ilgili önemli ilerlemeler olmuştur. Bunlardan ilki palyatif bakımın halk sağlığı sistemine entegre edilmesidir (10)(11)(12). İkincisi, palyatif bakımın insan hakları mevzuatı içerisine alınmasıdır.…”

“…Palyatif ve yaşam sonu bakım hizmetleri başarılı hükümetler için bakım kalitesini artırmak ve yaşam sonu bakım maliyetlerini azaltmak amacıyla bir politika önceliği olmuştur. Bu sistemlerin entegre bir şekilde uygulanması bakım kalitesini, verimliliği, çalışan ve hasta memnuniyetini artırdığı gibi uluslararası bir öncelik olarak kabul edilmiştir (4,12,14,28,29…”