The challenges of uncertainty and interprofessional collaboration in palliative care for non-cancer patients in the community: A systematic review of views from patients, carers and health-care professionals

Abstract

Background:Primary care has the potential to play significant roles in providing effective palliative care for non-cancer patients.Aim:To identify, critically appraise and synthesise the existing evidence on views on the provision of palliative care for non-cancer patients by primary care providers and reveal any gaps in the evidence.Design:Standard systematic review and narrative synthesis.Data sources:MEDLINE, Embase, CINAHL, PsycINFO, Applied Social Science Abstract and the Cochrane library were searched in 2012. Reference searching, hand searching, expert consultations and grey literature searches complemented these. Papers with the views of patients/carers or professionals on primary palliative care provision to non-cancer patients in the community were included. The amended Hawker’s criteria were used for quality assessment of included studies.Results:A total of 30 studies were included and represent the views of 719 patients, 605 carers and over 400 professionals. In all, 27 studies are from the United Kingdom. Patients and carers expect primary care physicians to provide compassionate care, have appropriate knowledge and play central roles in providing care. The roles of professionals are unclear to patients, carers and professionals themselves. Uncertainty of illness trajectory and lack of collaboration between health-care professionals were identified as barriers to effective care.Conclusions:Effective interprofessional work to deal with uncertainty and maintain coordinated care is needed for better palliative care provision to non-cancer patients in the community. Research into and development of a best model for effective interdisciplinary work are needed.

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

“…Palliative care is recognized as an important component of care for all patients with life-limiting illness (1,2); however, historically, palliative care has been focused on patients with malignant diseases (1,3,4) and has been underused in patients with chronic lung disease (1). Recently, interest has grown in providing palliative care for patients with chronic lung disease, including chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) (1,5,6).…”

Qualitative Study for the Development of a Telemedicine System in Palliative Care

“…17 With respect to the multidisciplinary approach, mentioned by health professionals as a vital point in the quality care of palliative and chronic patients, the literature shows a clear effectiveness of this type of equipment to achieve better management of these patients. 23 Some of the emerging themes identified during the interviews were pain management, non-systematic types of knowledge, unnecessary monitoring in terminally ill patients, and multidisciplinary dimension for palliative care. These fields have also been shown to be potentially improved by the use of ICTs; however, the analysis of the exact form of implementation will require further studies in the field.…”

Dispensing errors and uncertainty: Perspectives of pharmacists in a tertiary health facility in Lagos, Nigeria

“…The impact of uncertainty in various aspects of health care delivery system has been documented, especially in the areas of decision making, operations, interprofessional collaboration, coping behavior of patients, and doctors, and in nursing practice setting. [27,[33][34][35] This work therefore aims to identify the forms of dispensing errors, and uncertainty in the tertiary hospital and their implications for patient safety.…”