Strengthening palliative care in the hospital setting: a codesign study

Abstract

ObjectiveTo identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families.MethodsA codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus.ResultsMore than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care.ConclusionsChanges to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.

Preferences of patients with palliative care needs and their families for engagement with service improvement work within the hospital setting: A qualitative study

“…29 That such data needs to inform care through appropriate reporting mechanisms and response by those able to affect a change in care provision is well stated. 13,28,30 Participants noted their strong preference for an identified key person with whom they can liaise on a day-to-day basis in relation to care provision. The potential for this role to be supported through integrated nurse specialist roles and/or ward based nursing leadership is well described.…”

“…The potential for this role to be supported through integrated nurse specialist roles and/or ward based nursing leadership is well described. [30][31][32] Collection of patient/family reported data to inform both care (identifiable data) and service improvement (deidentified data), through carefully established mechanisms to deidentify and collate available data, is an important area of innovation requiring progress.…”

Development of a national quality framework for palliative care in a mixed generalist and specialist care model: A whole-sector approach and a modified Delphi technique

“…For the development of this national quality framework for palliative care, we adhered to the Guideline for Guidelines [ 47 ], a complementary tool to the revised international criteria for Appraisal for Guidelines of Research and Evaluation (AGREE II) [ 48 ]. Considering the broad scope and the multidisciplinary nature of palliative care as well as an extensive amount of stakeholders, we employed a whole-sector approach [ 19 ] and consulted an expert panel in a modified Delphi technique to answer the research question [ 49 – 51 ]. We structured the development into three phases: Preparation, development, and finalisation ( Fig 1 ).…”

“…Additionally, most healthcare professionals lack sufficient training and skills in symptom management, communication, and care coordination [ 15 , 16 ]. Poor interdisciplinary teamwork and limited communication combined with a lack of early identification of patients with palliative care needs contribute to the provision of sub-optimal palliative care [ 17 – 19 ]. Therefore, patients in a palliative care trajectory continue to receive inappropriate treatments at the end of their lives, often leading to poor quality and high-cost care [ 6 , 20 , 21 ].…”

“…With the intent to improve availability and access to high-quality palliative care for all people with life-threatening illnesses, we developed a national consensus-based quality framework for the optimal organisation and delivery of patient-centred palliative care in a mixed generalist and specialist palliative care model [ 45 ]. We hypothesised that a whole-sector approach and a modified Delphi technique could be beneficial for the broad recognition and integration of palliative care [ 19 , 46 ]. The process of development and consensus-building and its key elements are presented here.…”