Abstract
Background: In response to population aging, there is a need for health systems to focus on care for chronic disease, specifically palliative care, while focusing on people-centered care. The objective of this study is to explore the healthcare system enablers and barriers to the provision of quality palliative and end-of-life care from the perspective of healthcare professionals. Materials and Methods: Using purposive sampling, fifteen focus group interviews and nine individual interviews involving 72 healthcare providers were conducted. Primary qualitative data were collected between May 2016 and July 2017. All recorded discussions were transcribed verbatim and analyzed. A thematic framework was developed. Results: The provision of quality palliative and end-of-life care is influenced by the interaction and integration of nine sub-themes under four identified themes: (1) political context; (2) organization setting; (3) support to patients, caregivers, and family members, and (4) healthcare workers and the public. Conclusions: Integration of palliative and end-of-life care is an important pillar of healthcare service to improve quality of life by addressing patients’ values, wishes and preference, and assist their family to handle challenges at the end stage of life. Further improvements to the service framework would be required, specifically in the political framework, multidisciplinary approach, and readiness and competence in healthcare workers and community. These were highlighted in our study as key components in service provision to ensure that patients can receive continuous and integrated care between hospitals and the community as well as dignified care at the end stage of life.
Highlights
In response to population aging, there is a need for health systems to focus on care for chronic disease, palliative care, while focusing on people-centered care
Continued efforts would still be required to ensure that the quality and accessibility of palliative care services [2,4]
While the stages from disease diagnosis to death may be progressive or regressive, the provision of quality palliative and EOL care is influenced by the interaction and integration of nine sub-themes under four identified themes: (1) political context; (2) organization setting; (3) support to patients, caregivers, and family members; and (4) healthcare workers and public (Table 2)
Summary
In response to population aging, there is a need for health systems to focus on care for chronic disease, palliative care, while focusing on people-centered care. The estimated number of adults in need of palliative care at the end-of-life (EOL) is over 19 million [1], and, in England and Wales, it is projected that in 2040 56% of people aged 85 and older will require palliative care [2]. Health systems around the world have increased palliative care services by establishing palliative care units and piloting various inpatient and community palliative care programs to increase the availability and access to the population [3]. Continued efforts would still be required to ensure that the quality and accessibility of palliative care services [2,4]. Public Health 2020, 17, 5130; doi:10.3390/ijerph17145130 www.mdpi.com/journal/ijerph
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