Quality palliative care for cancer and dementia in five European countries: some common challenges

Abstract

ObjectivesThere is a growing consensus worldwide that palliative care needs to be both more inclusive of conditions other than cancer and to improve. This paper explores some common challenges currently faced by professionals providing palliative care for patients with either cancer or dementia across five countries.MethodOne focus group (n = 7) and 67 interviews were conducted in 2012 across five countries: England, Germany, Italy, the Netherlands and Norway, with professionals from dementia, cancer and palliative care settings.ResultsThe interviews revealed five common challenges faced across the five countries: communication difficulties (between services; and between professionals, and patients and their families); the variable extent of structural/functional integration of services; the difficulties in funding of palliative care services; problematic processes of care (boundaries, definitions, knowledge, skills and inclusiveness) and, finally, time constraints.ConclusionThese are not problems distinct to palliative care, but they may have different origins and explanations compared to other areas of health care. This paper explored deeper themes hidden behind a discourse about barriers and facilitators to improving care.

Barriers to the provision of high-quality palliative care for people with dementia in England: a qualitative study of professionals' experiences

“…IMPACT is developing and testing quality indicator packages as tools for improving palliative care across settings and systems (Davies et al . , Iliffe et al . ) and is being carried out in England, Germany, Italy, Norway and the Netherlands.…”

Achieving consensus and controversy around applicability of palliative care to dementia

“…Perhaps exposure helps practitioners to recognize the benefits of early integration of palliative care principles in the care for these patients. Moreover, research on end-of-life care for patients with dementia has traditionally been compared with care for cancer patients (Davies et al, 2014). Further, in case scenario studies on decisions at the end of life or in older people, in multiple countries, there was either no association with physician's age (Molloy et al, 1991) or older physicians were more likely to choose less aggressive treatment (Alemayehu et al, 1991) or to withdraw treatment (Hinkka et al 2002).…”

What is important at the end of life for people with dementia? The views of people with dementia and their carers

“…Exploring the views and preferences of all stakeholders involved in EoL care in dementia is necessary to evaluate current provision and inform how care can be improved. Often, the perspectives, experiences and opinions sought are those of family carers (Treloar et al, ; Hennings et al, ; Davies et al, ), healthcare professionals (Livingston et al, ; Davies et al, ; Lee et al, ) or sometimes both (Thuné‐Boyle et al, ; Lawrence et al, ; Raymond et al, ), but it is also important to seek the views of those who are in receipt of EoL care. Some initial work has been undertaken with people with dementia and their carers to explore whether they were able to generate and prioritise preferences for EoL care (Dening et al, ).…”