Healthcare providers’ views and experiences of non-specialist palliative care in hospitals: A qualitative systematic review and thematic synthesis

Abstract

Background: Healthcare providers working in hospitals are frequently exposed to patients with palliative care needs. For most patients, these reflect non-specialist rather than specialist palliative care needs. Embedding palliative care principles early in patients’ disease trajectories within acute care delivery in hospitals, however, is a challenge. How to best understand the experiences of those providing non-specialist palliative care in hospitals has not been systematically assessed. Aim: To synthesise the evidence on healthcare providers’ views and experiences of non-specialist palliative care in hospitals. Design: A qualitative systematic review and thematic synthesis using Thomas and Harden’s thematic synthesis framework. Data sources: Databases of MEDLINE, CINAHL, PsycINFO and EMBASE were searched from date of inception to March 2018. Studies were eligible for inclusion if they reported on healthcare providers’ views and experiences of non-specialist palliative care in hospitals. Studies were appraised for quality but not excluded on that basis. The review was prospectively registered with the International Prospective Register of Systematic Reviews. Results: Thirty-nine papers of 37 studies were included, representing 985 hospital healthcare providers’ views and experiences. Four major analytical themes emerged; ‘Understanding of Palliative Care’, ‘Complexities of Communication’, ‘Hospital Ecosystem’ and ‘Doctors and Nurses – a Different Lens’. Conclusions: Non-specialist palliative care in hospitals is operationalised as care in the last weeks and days of life. The organisation of acute care, inter-disciplinary working practices, clinician attitudes, poor communication structures and lack of education and training in palliative care principles exacerbates poor implementation of this care earlier for patients in hospitals.

Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

“…Spending more time with patients enables doctors to build a curative relationship and foster rapport, which demonstrates empathy and allows patients to express their psychosocial concerns [ 34 ]. This finding is supported by recent studies [ 35 – 39 ] showing that doctors spending more time discussing information about disease or treatment guidelines in prognostic conversations allows patients to gain a greater understanding of their illness and treatment options.…”

Structure and Process of Palliative Care Provision: A Nationwide Study of Public Hospitals in Thailand

“…Spending more time with patients enables doctors to build a curative relationship and foster rapport, which demonstrates empathy and allows patients to express their psychosocial concerns [34]. This nding is supported by recent studies [35][36][37][38][39] showing that doctors spending more time discussing information about disease or treatment guidelines in prognostic conversations would give patients greater understanding about their illness and treatment options.…”

Strengthening palliative care in the hospital setting: a codesign study

“…Poor inter-disciplinary teamwork and limited communication combined with a lack of early identification of patients with palliative care needs all contribute to sub-optimal palliative care provision. [15][16][17][18][19][20] Translating patient and family care priorities into actionable strategies is critical to drive the policy reforms required and enable clinicians and managers to implement best palliative care at the ward level.…”