Generalist, specialist, or expert in palliative care? A cross-sectional open survey on healthcare professionals’ self-description.

Abstract

Background In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs) if possible, and by palliative care specialists if necessary. However, it still needs to be clarified what specialist expertise entails, what specialized care consists of, and which training or work experience is needed to become a palliative care specialist. In addition to generalists and specialists, ‘experts’ in palliative care are recognized within the nursing and medical professions, but it is unclear how these three roles relate. This study aims to explore how HCPs working in palliative care describe themselves in terms of generalist, specialist, and expert and how this self-description is related to their work experience and education. Methods A cross-sectional open online survey with both pre-structured and open-ended questions among HCPs who provide palliative care. Analyses were done using descriptive statistics and thematic coding of open-ended questions. Results 854 HCPs filled out the survey; 74% received additional training, and 79% had more than five years of working experience in palliative care. Based on working experience, 17% describe themselves as a generalist, 34% as a specialist, and 44% as an expert. Almost three out of four HCPs attributed their level of expertise on both their education and their working experience. Self-described specialists and experts had more working experience in palliative care, often had additional training, attended to more patients with palliative care needs, and were more often physicians. 76% consider it important to have both specialists and experts in palliative care. However, there were divergent perspectives on the distinction between specialist and expert. HCPs wish more clarity about what defines a specialist or an expert, how to become a specialist or expert, and when you need a specialist or an expert. Conclusions Although the grounds on which HCPs describe themselves as generalist, specialist, or experts differ, HCPs who describe themselves as specialists or experts mostly do so based on both their post-graduate education and their work experience. HCPs find it important to have specialists and experts in palliative care in addition to generalists and indicate more clarity about (the requirements for) these three roles is needed.