13 Practices, issues and possibilities at the interface between geriatrics and palliative care within the hospital: an exploratory study (InGaP)

Abstract

Introduction With the expansion of palliative care into non-malignant conditions, there is an increasing emphasis on inter-disciplinary working between extended geriatric teams and palliative care. This inter-disciplinary working has evolved organically and more needs to be known about current working practices. This is of policy and clinical interest as the elderly patient population continues to grow. Methods An exploratory case study was undertaken of end-of-life care for older in-patients in a London hospital. Staff from all grades and roles within palliative care and geriatric medical/nursing teams, patients and carers were invited to be interviewed, according to a protocol approved by HRA. 30 semi-structured qualitative interviews were conducted with staff, two with patients and five with carers. Questions covered: recent examples where teams worked together; staff perceptions of collaboration, working practices and issues; patient and carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; suggestions for future practice. Results Participants were overwhelmingly positive about collaboration between the teams. Examples of what currently works well were: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas of concern and for future development were: improving collaboration between palliative care and physiotherapy and occupation health; the need for continual on-ward education given rotation of junior medical staff; embedding palliative care within multidisciplinary team meetings within the ward. Patients and carers did not generally distinguish between the teams and presumed collaborative working practices. Conclusions A commitment to working together was important. The findings are also relevant to understanding good practice between older persons ward teams and other specialisms.