Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review

Gardiner, Clare; Gott, Merryn; Ingleton, Christine

doi:10.3399/bjgp12x641474

Cited by 118 publications

(153 citation statements)

References 31 publications

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“…The findings described here are all the more striking for having emerged from interviews with a small number of providers caring for the same group of patients at a single medical center. Themes related to shared vision, role delineation, and collaboration around ACP also resonate with published work in other settings and populations, supporting the broader relevance of our findings (18,32,(49)(50)(51)(52)(53)(54)(55)(56). Nevertheless, our study does not provide information on how ACP for patients with advanced kidney disease is approached at other centers within or outside the VA.…”

Section: Discussionmentioning

confidence: 30%

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

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Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.Results The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. ConclusionsThe comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

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Section: Discussionmentioning

confidence: 30%

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

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“…An important area for future attention is to agree core concepts as this will aid partnership working and support earlier access to the most appropriate forms of care [53][54][55]. Currently, the majority of people receive end of life from generalists such as GPs and district nurses rather than from those who have received specialist training in palliative care [53].…”

Section: Discussionmentioning

confidence: 99%

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

et al. 2018

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Background: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. Methods: The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014)(2015)(2016) Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. Results: Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. Conclusions: Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

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“…The need for clear communication, effective MDT working, and definition of roles and responsibilities is ongoing. 25 Much EOLC occurs during evenings, nights, and at weekends, when the delivery of EOLC can be particularly challenging for a number of possible reasons, including the nature of OOH work, the reasons why GPs work in OOH services, and a feeling of isolation described by GPs working in OOH services within the system. 26 Effective, consistent IT communication systems, and sharing of patient records, including handover of sensitive information regarding EOLC, is a continuing need.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

et al. 2016

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BackgroundWith increasing numbers of people living with complex life-limiting multimorbidity in the community, consideration must be given to improving the organisation and delivery of highquality palliative and end-of-life care (EOLC). AimTo provide insight into the experience of GPs providing EOLC in the community, particularly the facilitators and barriers to good-quality care. Design and settingA web-based national UK questionnaire survey circulated via the Royal College of General Practitioners, NHS, Marie Curie, and Macmillan networks to GPs. MethodResponses were analysed using descriptive statistics and an inductive thematic analysis. ResultsResponses were received from 516 GPs, who were widely distributed in terms of practice location. Of these, 97% felt that general practice plays a key role in the delivery of care to people approaching the end of life and their families. Four interdependent themes emerged from the data: continuity of care -which can be difficult to achieve because of resource concerns including time, staff numbers, increasing primary care workload, and lack of funding; patient and family factors -with challenges including early identification of palliative care needs and recognition of the end of life, opportunity for care planning discussions, and provision of support for families; medical management -including effective symptomcontrol and access to specialist palliative care services; and expertise and training -the need for training and professional development was recognised to enhance knowledge, skills, and attitudes towards EOLC. ConclusionThe findings reveal enduring priorities for policy, commissioning, practice development, and research in future primary palliative care.

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Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review

Cited by 118 publications

References 31 publications

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

Providing end-of-life care in general practice: findings of a national GP questionnaire survey

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