The Palliative Care Challenge: Analysis of Barriers and Opportunities to Integrate Palliative Care in Europe in the View of National Associations

Centeno, Carlos; Garralda, Eduardo; Carrasco, José Miguel; Eerden, Marlieke den Herder-van der; Aldridge, Melissa D.; Stevenson, David G.; Meier, Diane E.; Hasselaar, Jeroen

doi:10.1089/jpm.2017.0039

Cited by 72 publications

(61 citation statements)

References 23 publications

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“…Globally, there are increasing calls for reforms that would allow government health agencies to integrate palliative care into primary care [51,55,56]. However, it is still unclear how such integration would be achieved and the process is likely to be challenging [57][58][59]. Lack of both standardised clinical pathways and systems for informationsharing have impeded the establishment of stable and integrated EOL care across relevant agencies [60].…”

Section: Discussionmentioning

confidence: 99%

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End-of-life care in rural general practice: how best to support commitment and meet challenges?

et al. 2019

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Background: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. Methods: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. Results: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. Conclusions: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.

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Section: Discussionmentioning

confidence: 99%

“…Internal players (i.e. primary care and palliative care providers, local healthcare organisations) should ensure local needs and capacity are fully considered, whereas external players need to strengthen healthcare infrastructures through evidencebased decisions on funding, staffing, regulation and legislation [58,60,64].…”

Section: Discussionmentioning

confidence: 99%

End-of-life care in rural general practice: how best to support commitment and meet challenges?

et al. 2019

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“…Although the consistency of our results with other studies supports the validity of the findings, further research with an additional sample of IPC leaders may be helpful to confirm our findings. As a result, another InSup-C study by Centeno et al (2017) investigated leaders’ opinions on barriers and opportunities to the integration of palliative care according to levels of service provision across Europe. Notwithstanding these limitations, this study is a good starting point for further in-depth investigation of IPC.…”

Section: Discussionmentioning

confidence: 99%

Towards accessible integrated palliative care

Eerden

Ewert

Hodiamont

et al. 2017

JICA

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PurposeLiterature suggests that integrated palliative care (IPC) increases the quality of care for palliative patients at lower costs. However, knowledge on models encompassing all integration levels for successfully implementing IPC is scarce. The purpose of this paper is to describe the experiences of IPC leaders in seven European countries regarding core elements, facilitators and barriers of IPC implementation and provides recommendations for future policy and practice.Design/methodology/approachA qualitative interview study was conducted between December 2013 and May 2014. In total, 34 IPC leaders in primary and secondary palliative care or public health in Belgium, Germany, Hungary, Ireland, the Netherlands, Spain and the UK were interviewed. Transcripts were analysed using thematic data analysis.FindingsIPC implementation efforts involved a multidisciplinary team approach and cross-sectional coordination. Informal professional relationships, basic medical education and general awareness were regarded as facilitators of IPC. Identified barriers included lack of knowledge about when to start palliative care, lack of collaboration and financial structures. Recommendations for improvement included access, patient-centeredness, coordination and cooperation, financing and ICT systems.Originality/valueAlthough IPC is becoming more common, action has been uneven at different levels. IPC implementation largely remains provisional and informal due to the lack of standardised treatment pathways, legal frameworks and financial incentives to support multilevel integration. In order to make IPC more accessible, palliative care education as well as legal and financial support within national healthcare systems needs to be enhanced.

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“…Less is known about factors associated with long-term sustainable implementation, which may be different from those affecting short-term implementation. In addition, studies have shown difficulties when implementing palliative care in general healthcare settings where there is not an exclusive focus on patients in the palliative phase, such as home-care and hospital settings [7][8][9][10][11]. This study provides insight into strategies and factors affecting sustainable implementation of innovations in palliative care in a nationwide Dutch Quality Improvement Programme in which palliative care innovations were implemented mainly in general healthcare settings.…”

Section: Introductionmentioning

confidence: 95%

Sustainment of Innovations in Palliative Care: A Survey on Lessons Learned From a Nationwide Quality Improvement Program

Veer

Fleuren

Voss

et al. 2021

Journal of Pain and Symptom Management

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The Palliative Care Challenge: Analysis of Barriers and Opportunities to Integrate Palliative Care in Europe in the View of National Associations

Abstract: A set of barriers and opportunities to PC integration has been identified across Europe, by national associations, offering a barometer against which to check the challenge of integration across countries.

Cited by 72 publications

References 23 publications

End-of-life care in rural general practice: how best to support commitment and meet challenges?

End-of-life care in rural general practice: how best to support commitment and meet challenges?

Towards accessible integrated palliative care

Sustainment of Innovations in Palliative Care: A Survey on Lessons Learned From a Nationwide Quality Improvement Program

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