Towards accessible integrated palliative care

Marlieke Den Herder-Van Der Eerden,Farina Hodiamont,Jeroen Hasselaar,Lukas Radbruch,Benjamin Ewert,Michaela Hesse

doi:10.1108/jica-03-2017-0006

Abstract

PurposeLiterature suggests that integrated palliative care (IPC) increases the quality of care for palliative patients at lower costs. However, knowledge on models encompassing all integration levels for successfully implementing IPC is scarce. The purpose of this paper is to describe the experiences of IPC leaders in seven European countries regarding core elements, facilitators and barriers of IPC implementation and provides recommendations for future policy and practice.Design/methodology/approachA qualitative interview study was conducted between December 2013 and May 2014. In total, 34 IPC leaders in primary and secondary palliative care or public health in Belgium, Germany, Hungary, Ireland, the Netherlands, Spain and the UK were interviewed. Transcripts were analysed using thematic data analysis.FindingsIPC implementation efforts involved a multidisciplinary team approach and cross-sectional coordination. Informal professional relationships, basic medical education and general awareness were regarded as facilitators of IPC. Identified barriers included lack of knowledge about when to start palliative care, lack of collaboration and financial structures. Recommendations for improvement included access, patient-centeredness, coordination and cooperation, financing and ICT systems.Originality/valueAlthough IPC is becoming more common, action has been uneven at different levels. IPC implementation largely remains provisional and informal due to the lack of standardised treatment pathways, legal frameworks and financial incentives to support multilevel integration. In order to make IPC more accessible, palliative care education as well as legal and financial support within national healthcare systems needs to be enhanced.

Highlights

Palliative care aims to prevent and alleviate suffering of patients with life-threatening diseases and their families by early identifying and treating their multidimensional symptoms (Sepulveda et al, 2002)
This paper describes the findings of these interviews, focussing on barriers and facilitators experienced during integrated palliative care (IPC) implementation and recommendations to make IPC more accessible
IPC interventions named by participants Patient groups Referral point to palliative care Professionals involved Organisations involved Access to IPC service Advance Care Planning Coordination strategy Continuation of care Education and training Sharing of expertise Guidelines and best practices Quality assessment Payment structure Transfer of information

Summary

Introduction

Palliative care aims to prevent and alleviate suffering of patients with life-threatening diseases and their families by early identifying and treating their multidimensional symptoms (Sepulveda et al, 2002). Several studies have shown that palliative care is effective in terms of quality of life and costs (Temel et al, 2010; Bakitas et al, 2009; Zimmermann et al, 2014; Dalgaard et al, 2014). Studies demonstrating the effectiveness of palliative care integration incorporate specific palliative care components (e.g. routine screening, assessment and support of multidimensional symptoms, advance care plans and a multidisciplinary team approach) into standard care for patients with life-threatening diseases (Temel et al, 2010; Bakitas et al, 2009; Zimmermann et al, 2014; Dalgaard et al, 2014). Despite these references to integrated care in a palliative care context, knowledge on models encompassing all integration levels and preconditions for successfully implementing IPC in both oncology and non-oncology is scarce and requires further investigation (Boland et al, 2013; Bruera and Hui, 2012; Gadoud et al, 2013)

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