Delivering Palliative Care in an Acute Hospital Setting: Views of Referrers and Specialist Providers

Gail Ewing, Morag Farquhar, Sara Booth

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)

Abstract

There has been a steady expansion of hospital-based palliative care in the United Kingdom but limited published research on health professionals' views of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the reasons for referral, beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were tape recorded and transcribed verbatim. Data were analyzed thematically using a framework analysis approach. The study found large areas of agreement between referrers and providers on what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility on the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care was also identified; in particular, whether specialists should be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation of specialist advice by referrers. Such perspectives on the interface of generalist and specialist provision provide insights into improving care for palliative patients in the acute hospital setting.
Original languageEnglish
Pages (from-to)327-340
Number of pages14
JournalJournal of Pain and Symptom Management
Volume38
Issue number3
Early online date25 Jun 2009
DOIs
Publication statusPublished - Sep 2009

Keywords

  • Palliative care
  • hospital
  • symptom control
  • psychological support
  • accessibility
  • referrers
  • specialist services
  • evaluation

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