A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community

Abstract

BackgroundThis paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind.MethodsUsing qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams.ResultsSustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward.ConclusionsThis study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions.

Community Based Programs Sustainability. A Multidimensional Analysis of Sustainability Factors

“…While sustainability is widely recognized in the literature, the concept itself is inconsistently defined [26], given the multiple dimension and stakeholders involved [7]. In a very broad way, sustainability is defined as "whether or not something continues to work over time" [27].…”

“…In a very broad way, sustainability is defined as "whether or not something continues to work over time" [27]. Other approaches are more detailed, with some scholars considering sustainability as addressing the program continuity in its entirety, while others addressed continuity of specific program components [26], improvement of community capacity, programs institutionalisation [19] or the capacity of the program to continuously respond to community issues [28]. These divergent definitions attest that definitional consensus has not been made, and congruent sustainability factors are considered by various scholars or practitioners.…”

Education, Training, and Mentorship of Caregivers of Canadians Experiencing a Life-Limiting Illness

“…Taken one step further, the palliative navigator would also be a member of, where available, the palliative care team, which is an interdisciplinary team of practitioners (including social work and spiritual care) that have shown to be particularly effective in rural areas. 7,20 Education, training, and mentorship…”

Evaluating the Sustainability of Community-Based Long-Term Care Programmes: A Hybrid Multi-Criteria Decision Making Approach

“…One of the few studies we found conducted a longitudinal case study by Demiglio and Williams [17] to examine the sustainability of the shared care model among five alternative care teams. Theurer et al studied the mutual support group intervention in long-term care homes and addressed replication and sustainability [18].…”