Professionals’ experiences with palliative care and collaboration in relation to a randomised clinical trial: a qualitative interview study

Abstract

Scand J Caring Sci; 2020; 34: 305-313 Professionals' experiences with palliative care and collaboration in relation to a randomised clinical trial: a qualitative interview study Background: International evidence on the outcome of generalist versus specialist palliative care provision in palliative care trajectories is limited and varied. In general, intervention studies can influence the organisation of palliative care practice and professional collaborations. However, randomised clinical trials in palliative care rarely consider the organisational significance of the studies, as experienced by the professionals involved. DOMUS is the abbreviation for a Danish intervention study designed as a randomised clinical trial, investigating an accelerated transition from oncological to specialist palliative care at home for patients with incurable cancer. Alongside conducting the palliative care intervention study, we wanted to discover the perspectives of the healthcare professionals involved. Aim: To explore the organisational significance of the DOMUS intervention study as experienced by the professionals involved. Design: A qualitative interview study, using thematic content analysis and inspired by organisational theory.Setting/participants: Thirty-eight professionals from four units involved in the DOMUS intervention study took part in 10 groups and six individual interviews. Results: The DOMUS randomised clinical trial intervention influenced and sometimes disrupted both the ways of organising, collaborating and practising palliative care, and patients' and relatives' understanding of their own situation. It did this by (1) referring a broader palliative care target group to specialist palliative care, leading to (2) different palliative care needs, professional tasks, and perceived impact on (3) the organisation of palliative care and (4) professional collaboration. Conclusion: Professionals involved in the DOMUS palliative care intervention found that the study had organisational significance, with an influence on professionals, patients and relatives. Specialist palliative care in Denmark is devoted organisationally and professionally to patients with severe or complex palliative care needs. Hence, new ways of organising palliative care for people in the earlier stages of their disease are needed.

Challenges faced by Chinese community nurses when providing home-based hospice and palliative care: a descriptive qualitative study

“…HBHPC is a new form of nursing practice that nurses felt they were not sufficiently prepared for. According to organization theory [ 27 , 28 ], new approaches to HBHPC likely entailed organizational changes. These variations subsequently created feelings of insecurity and confusion among the nurses involved related to care coordination, multidisciplinary collaboration, and expectations about their own and other specialists’ roles [ 27 , 28 ].…”

“…According to organization theory [ 27 , 28 ], new approaches to HBHPC likely entailed organizational changes. These variations subsequently created feelings of insecurity and confusion among the nurses involved related to care coordination, multidisciplinary collaboration, and expectations about their own and other specialists’ roles [ 27 , 28 ]. Previous studies have shown that educating nurses about the benefits of HBHPC could increase their understanding and motivation to serve [ 29 ].…”

Komplekse interventioner i den kommunale palliative indsats: organisatoriske faktorer der fremmer udvikling, afprøvning og forankring

“…Dertil kommer vanskeligheder i det tvaerfaglige samarbejde bl.a. mellem hjemmesygepleje/plejehjem og almen praksis, som er centrale organisationer når familierne i palliative forløb er hjemme (7)(8)(9)(10). Udfordringerne kan bl.a.…”

“…Dette betyder bl.a. forskellig arbejdslogik med forskelligt behov for arbejdstilrettelaeggelse (7,10). Som det fremgår, peger en del studier på organisatoriske udfordringer.…”

“…På trods af at almen praksis var involveret i alle fire kommuners projekter var der kun to praktiserende laeger, som takkede ja til at deltage i interviewundersøgelsen. Andre studier viser tilsvarende udfordringer både i forhold til, at praktiserende laeger er vanskelige at involvere i konkret kommunale forsknings-/udviklingsprojekter målrettet palliation og evaluering af disse (7,10). Det betyder at der i mindre grad bliver genereret og kumuleret viden om, hvordan almen praksis kan bidrage til at forbedre den palliative indsats i kommuner, herunder forbedringspotentialer omkring samarbejde med andre organisationer og faggrupper.…”