Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Abstract

BackgroundGeneralists such as general practitioners and district nurses have been the main actors in community palliative care in Norway. Specialised oncology nurses with postgraduate palliative training are increasingly becoming involved. There is little research on their contribution. This study explores how general practitioners (GPs) and oncology nurses (ONs) experience their collaboration in primary palliative care.MethodsA qualitative focus group and interview study in rural Northern Norway, involving 52 health professionals. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically.ResultsThe ideal cooperation between GPs and ONs was as a “meeting of experts” with complementary competencies. GPs drew on their generalist backgrounds, including their often long-term relationship with and knowledge of the patient. The ONs contributed longitudinal clinical observations and used their specialised knowledge to make treatment suggestions. While ONs were often experienced and many had developed a form of pattern recognition, they needed GPs’ competencies for complex clinical judgements. However, ONs sometimes lacked timely advice from GPs, and could feel left alone with sick patients. To avoid this, some ONs bypassed GPs and contacted palliative specialists directly.While traditional professional hierarchies were not a barrier, we found that organization, funding and remuneration were significant barriers to cooperation. GPs often did not have time to meet with ONs to discuss shared patients. We also found that ONs and GPs had different strategies for learning. While ONs belonged to a networking nursing collective aiming for continuous quality improvement, GPs learned mostly from their individual experience of caring for patients.ConclusionsThe complementary competences and autonomous roles of a specialised nurse and a general practitioner represented a good match for primary palliative care. When planning high-quality teamwork in primary care, organizational barriers to cooperation and different cultures for learning need consideration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2955-7) contains supplementary material, which is available to authorized users.

Leadership in specialist palliative home care teams: A qualitative study

“…For effective teamwork in specialist palliative care, leadership is crucial (Dahlin, Coyne, Goldberg, & Vaughan, ); however, defining and agreeing on what leadership comprises may be challenging. One reason for the focus on teamwork in palliative care is the potential for effectively combining diverse skills and perspectives to better meet the complex needs of patients and families facing life‐threatening illness and death (Ciemins, Brant, Kersten, Mullette, & Dickerson, ; Johansen & Ervik, ; Wagner, ). Gardner () has outlined the tasks of leadership as envisioning goals, affirming values, motivating, managing, achieving a workable unity, explaining, serving as a symbol, representing the group and renewing.…”

Healthcare professionals’ perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway

“…We found that GPs were eager to recognize the older women as worthy human beings, but seemed to have reduced opportunities to do so, as well as less willingness to accomplish situations increasing the relative dignity -despite their duty to carry out home visits to patients incapable of traveling to the GP office (Regulations of the regular GP's scheme, 2012). Gallagher et al (2008) related GPs' limited awareness of the concept of dignity to staff attitudes and culture of care, whereas Johansen and Ervik (2018) drew attention to GPs' missing out of collective networks, learning primarily from individual-professional experiences.…”

“…Against this background, high quality end-of-life care for the rising number of older women with incurable cancer is now of great importance and should warrant sufficient healthcare resources, proper alleviation of symptoms, and respectful and supportive care (Cain & Denny, 2018;Rochon et al, 2020). This presupposes increasing demands on healthcare services and a multidisciplinary collaboration among healthcare professionals (HCPs) with complementary competencies to fulfil the complex needs of patients with incurable cancer (Johansen & Ervik, 2018).Figure 1 Despite the diversity in the term "older age" due to genetic inheritance and the environments in which older people live, we here define "old" from the age of 65 years in this study (WHO, 2020). Older people are often considered as a single group without taking account of gender differences, whereas care for older women requires an approach on aging, disease morbidity and treatment that is different from care for men (Gemmati et al, 2019;Rochon et al, 2020).…”

“…Their task is to fulfil an interdisciplinary role and have an overview of services available within and outside the municipality (Lie et al, 2018). Both GPs and CCs experience the ideal collaboration as a "meeting of experts" with complementary competencies (Johansen & Ervik, 2018). Using an individual plan of care can improve the HCP collaboration as well as strengthen their cooperation with the patients' relatives (Kjellevold & Skippervik, 2020).…”

Palliative care in rural and remote areas

“…The aim of this study is to explore the challenges faced by nurses in providing palliative cancer care in the northernmost part of Norway. There have been few studies in Norway of this particular nursing context (18,19), but more studies have been conducted in Canada, the USA and Australia on nurses' working conditions in rural palliative care (20)(21)(22)(23)(24).…”