Establishing key criteria to define and compare models of specialist palliative care: A mixed-methods study using qualitative interviews and Delphi survey

Abstract

Background: Specialist palliative care services have various configurations of staff, processes and interventions, which determine how care is delivered. Currently, there is no consistent way to define and distinguish these different models of care. Aim: To identify the core components that characterise and differentiate existing models of specialist palliative care in the United Kingdom. Design: Mixed-methods study: (1) semi-structured interviews to identify criteria, (2) two-round Delphi study to rank/refine criteria, and (3) structured interviews to test/refine criteria. Setting/participants: Specialist palliative care stakeholders from hospice inpatient, hospital advisory, and community settings. Results: (1) Semi-structured interviews with 14 clinical leads, from eight UK organisations (five hospice inpatient units, two hospital advisory teams, five community teams), provided 34 preliminary criteria. (2) Delphi study: Round 1 (54 participants): thirty-four criteria presented, seven removed and seven added. Round 2 (30 participants): these 34 criteria were ranked with the 15 highest ranked criteria, including setting, type of care, size of service, diagnoses, disciplines, mode of care, types of interventions, ‘out-of-hours’ components (referrals, times, disciplines, mode of care, type of care), external education, use of measures, bereavement follow-up and complex grief provision. (3) Structured interviews with 21 UK service leads (six hospice inpatients, four hospital advisory and nine community teams) refined the criteria from (1) and (2), and provided four further contextual criteria (team purpose, funding, self-referral acceptance and discharge). Conclusion: In this innovative study, we derive 20 criteria to characterise and differentiate models of specialist palliative care – a major paradigm shift to enable accurate reporting and comparison in practice and research.

Leadership in specialist palliative home care teams: A qualitative study

“…Although organizing health care professionals (HCP) in teams is a standard within palliative care (Gamondi, Larkin, & Payne, ), there are known challenges with teamwork. Some challenges seem inherent since palliative care teams can be organized in various ways (Firth et al, ). Two distinct examples are how team members interact, in parallel or more integrated (Reeves, Xyrichis, & Zwarenstein, ; Thylefors, Persson, & Hellstrom, ), and if roles and assignments are fixed or more fluid (Andreatta, ).…”

Cuidados paliativos: definição e estratégias utilizadas na prática médica

“…Na prática, os cuidados paliativos correspondem a intervenções orientadas por uma filosofia que abrange o cuidado em seus aspectos físicos, psíquicos, sociais e espirituais, realizadas por equipe multiprofissional. Esta modalidade de cuidado está indicada para pacientes portadores de doença grave e progressiva, que ameace a continuidade da vida e podem ser adequadamente oferecidos a qualquer momento ao longo da trajetória da doença, concomitantes ou não à terapêutica curativa (Firth, O'Brien, Guo, Seymour, Richardson, Bridges, Hocaoglu,et al, 2019).…”

Selecting Indicators to Monitor and Assess Environmental Health in a Portuguese Urban Setting: A Participatory Approach

“…Methods for selecting indicators vary from statistical and causal models [ 15 ] to systematic reviews of the literature [ 24 , 25 ] and participatory processes [ 26 , 27 , 28 , 29 ]. The use of participatory processes in EH research is especially important because of the complexity of the EH concept and of the interactions between EH determinants and health outcomes, as well as because of the importance of engaging experts with different knowledge in expressing their views and discussing local EH problems [ 30 , 31 ].…”

“…The Web-Delphi is being increasingly explored due to the use of technological platforms having the advantage of not requiring face to face contact, removing geographical barriers, and allowing the involvement of a large number of experts [ 36 ]. Delphi processes have been used to identify criteria to characterize and differentiate models of palliative care in healthcare services [ 27 ], to define core areas of EH [ 30 ], and to compare scenarios in order to improve urban sustainability development [ 37 , 38 ]. In this article, we propose the use of a Web-Delphi process as a tool to validate the information collected for a set of built and natural indicators.…”