Abstract
BackgroundThe PaTz-method (acronym for Palliatieve Thuiszorg, palliative care at home) is perceived to improve coordination, continuity and communication in palliative care in the Netherlands. Although important for further implementation, research showing a clear effect of PaTz on patient-related outcomes is scarce. This study aimed to examine perceived barriers and added value of PaTz and its association with improved care outcomes.MethodsNinety-eight Dutch general practitioners and 229 Dutch district nurses filled out an online questionnaire with structured questions on added value and barrier perception of PaTz-participation, and palliative care provided to their most recently deceased patient, distributed online by Dutch medical and nurses’ associations. Data from PaTz-participants and non-participants was compared using Chi-square tests, independent t-tests and logistic regression analyses.ResultsWhile both PaTz-participants and non-participants perceived PaTz to be beneficial for knowledge collaboration, coordination and continuity of care, time (or lack thereof) is considered the most important barrier for participation. PaTz-participation is associated with discussing five or more end-of-life topics with patients (OR = 3.16) and with another healthcare provider (OR = 2.55). PaTz-participation is also associated with discussing palliative sedation (OR = 3.85) and euthanasia (OR = 2.97) with another healthcare provider. Significant associations with other care outcomes were not found.ConclusionsGeneral practitioners and district nurses feel that participating in a PaTz-group has benefits, but perceive various barriers for participation. While participating in a PaTz-group is associated with improved communication between healthcare providers and with patients, the effect on patient outcomes remains unclear. To stimulate further implementation, future research should focus on the effect of PaTz on tangible care characteristics and how to facilitate participation and remove barriers.
Highlights
The PAlliatieve ThuisZorg (PaTz)-method is perceived to improve coordination, continuity and communication in palliative care in the Netherlands
Contrary to many other western countries like the US, Canada, the UK and Australia, palliative care is not a medical specialty in the Netherlands [2]. It is one of few countries where palliative care is provided in a coordinated care model [3] and national policy states that palliative care should principally be provided by generalists close to patients [4]. It is often provided by Dutch general practitioners (GPs, in some countries better known as family physicians), who can rely on national guidelines on palliative care provision [5], and on supportive services and facilities such as palliative care consultation teams [6]
While we found an association between participating in a PaTz-group and discussing more topics with another healthcare provider and with patients, we found no associations between PaTz-participation and other care characteristics
Summary
The PaTz-method (acronym for Palliatieve Thuiszorg, palliative care at home) is perceived to improve coordination, continuity and communication in palliative care in the Netherlands. Contrary to many other western countries like the US, Canada, the UK and Australia, palliative care is not a medical specialty in the Netherlands [2]. It is one of few countries where palliative care is provided in a coordinated care model [3] and national policy states that palliative care should principally be provided by generalists close to patients [4]. While communication with patients with a life-threatening disease and relatives on end-of-life topics has consistently been shown to improve quality of care [12,13,14], GPs struggle to have these conversations with their patients [15]
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