Non-specialist palliative care: A principle-based concept analysis

Abstract

Background:Building palliative care capacity among all healthcare practitioners caring for patients with chronic illnesses, who do not work in specialist palliative care services (non-specialist palliative care), is fundamental in providing more responsive and sustainable palliative care. Varying terminology such as ‘generalist’, ‘basic’ and ‘a palliative approach’ are used to describe this care but do not necessarily mean the same thing. Internationally, there are also variations between levels of palliative care which means that non-specialist palliative care may be applied inconsistently in practice because of this. Thus, a systematic exploration of the concept of non-specialist palliative care is warranted.Aim:To advance conceptual, theoretical and operational understandings of and clarity around the concept of non-specialist palliative care.Design:The principle-based method of concept analysis, from the perspective of four overarching principles, such as epistemological, pragmatic, logical and linguistic, were used to analyse non-specialist palliative care.Data sources:The databases of CINAHL, PubMed, PsycINFO, The Cochrane Library and Embase were searched. Additional searches of grey literature databases, key text books, national palliative care policies and websites of chronic illness and palliative care organisations were also undertaken.Conclusion:Essential attributes of non-specialist palliative care were identified but were generally poorly measured and understood in practice. This concept is strongly associated with quality of life, holism and patient-centred care, and there was blurring of roles and boundaries particularly with specialist palliative care. Non-specialist palliative care is conceptually immature, presenting a challenge for healthcare practitioners on how this clinical care may be planned, delivered and measured.

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

“…1 The requirement that palliative care be embedded in everyday practice and that all healthcare providers (nurses, doctors and allied healthcare staff) who have direct contact with patients should have, at a minimum, a basic knowledge of palliative care, is supported in policy in many countries. [2][3][4][5][6] Recognising that diversity in terminology exists, for example, 'generalist palliative care', 'primary palliative care', 'supportive care' and 'whole person care', 7 we use the term 'non-specialist palliative care' to reflect basic and intermediate levels of palliative care expertise in this article. Furthermore, where the broad term 'palliative care' is used, this refers to both specialist and nonspecialist palliative care provision.…”

InterRAI assessments: opportunities to recognise need for and implementation of palliative care interventions in the last year of life?

“…In addition to eliciting patient understanding of their illness, arguably there is value in the clinician (or in this case the interRAI assessor) using their clinical judgement to estimate prognosis. Adding, prognostic indicators 23 or tools such as the Clinical Frailty Scale 24 to decision‐making during an assessment may provide health professionals with the guidance needed to recognise when someone may be approaching the last year of their life and who may potentially benefit from a palliative care referral.…”

The rise of rapid implementation: a worked example of solving an existing problem with a new method by combining concept analysis with a systematic integrative review

“…The purpose of a concept analysis is to analyse, define, develop and evaluate ambiguous or complex concepts [18] and provide a precise definition. A number of methods have been developed to guide the analysis of a concept [19]. In a recent scoping review of concept analyses by Rodgers [20], the Wilson Method was the most commonly used (Walker & Avant, [21]; n = 465), followed by the evolutionary Method (Rodgers [22]; n = 213) and then the Principle-based Method (Morse et al [23]; n = 47).…”