Facilitators and Barriers to Interdisciplinary Communication between Providers in Primary Care and Palliative Care

Dudley, Nancy; Ritchie, Christine S.; Rehm, Roberta S.; Chapman, Susan; Wallhagen, Margaret

doi:10.1089/jpm.2018.0231

Cited by 28 publications

(46 citation statements)

References 34 publications

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“…Our training course has helped the HPs (i) develop a new concept of PC centred on the response to the needs of people [43] and not only to care; (ii) understand that PC can also be extended to non-oncological patients [44, 45] in advanced illness stages; (iii) gain empowerment and increased self-esteem from learning about the logistical and structural organization of PC to activate and implement PC [46–48]; (iv) appreciate the need to share personal aspects of their professional life; (v) appreciate the cooperation and joint multiple competences that enable a synergistic approach and enhanced outcomes [7, 49].…”

Section: Discussionmentioning

confidence: 99%

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Artioli

Bedini²,

Bertocchi

et al. 2019

BMC Palliat Care

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BackgroundDespite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals. The aim of this study was to evaluate the training’s impact on trainees within a hospital setting using Kirkpatrick’s and Moore’s models.MethodsWe adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick’s and Moore’s models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test.ResultsThe results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight:(i) the development of a new concept of palliative care, centred on the response to the holistic needs of people;(ii) that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals);(iii) the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC;(iv) the need to share personal aspects of their professional life (this result emerges only in qualitative research);(v) the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes.ConclusionIt is necessary to further develop rigorous research on training evaluation, at the most complex orders of the Kirkpatrick and Moore models, to measure primary PC skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients’ and families’ quality of life.

show abstract

Section: Discussionmentioning

confidence: 99%

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Artioli

Bedini²,

Bertocchi

et al. 2019

BMC Palliat Care

View full text Add to dashboard Cite

show abstract

“…3 It already seems overwhelming to be able to manage upward of 30 patients per day; it then becomes illogical for those 20 to 30 patients to be complex cases such as AHF that deserve a palliative focus. 16 The time restrictions primary care providers have with their patients, even if that patient is well known to the provider, create a greater need for specialist PC providers in the community. Unfortunately, there are not enough PC specialists in the community to meet such a high demand.…”

Section: Time Is Not On Our Sidementioning

confidence: 99%

“…The most consistently cited structural problem that interferes with primary care providers initiating and integrating PC is time constraint. 3,15,16,21 The allotted 15 to 20 minutes most providers have for a routine appointment with their patient leaves little physical time to even begin a PC conversation. Many providers acknowledge that the pressure of time restrictions reduces their ability to initiate end-of-life discussions or care for the patient’s family/caregivers.…”

Section: Literature Reviewmentioning

confidence: 99%

Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

Crimmins

Elliott

Absher

2020

Am J Hosp Palliat Care

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Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

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“…Our training course has helped the HPs (i) develop a new concept of PC centred on the response to the needs of people [43] and not only to care; (ii) understand that PC can also be extended to nononcological patients [44,45] in advanced illness stages; (iii) gain empowerment and increased selfesteem from learning about the logistical and structural organization of PC to activate and implement PC [46][47][48]; (iv) appreciate the need to share personal aspects of their professional life; (v) appreciate the cooperation and joint multiple competences that enable a synergistic approach and enhanced outcomes [7,49].…”

Section: Discussionmentioning

confidence: 99%

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Artioli

Bedini²,

Bertocchi

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Despite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals. The aim of this study was to evaluate the training's impact on trainees within a hospital setting using Kirkpatrick’s and Moore's models. Methods: We adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick’s and Moore’s models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test. Results: The results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight:the development of a new concept of palliative care, centred on the response to the holistic needs of people; that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals); the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC; the need to share personal aspects of their professional life (this result emerges only in qualitative research); the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes. Conclusion: It is necessary to further develop rigorous research on training evaluation, at the most complex orders of the Kirkpatrick and Moore models, to measure primary PC skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients’ and families’ quality of life.

show abstract

Facilitators and Barriers to Interdisciplinary Communication between Providers in Primary Care and Palliative Care

Cited by 28 publications

References 34 publications

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation

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