Understanding the acute care context to inform palliative care improvements: a qualitative study of hospital-based multidisciplinary clinicians.
Background: Population ageing and rising levels of non-communicable diseases are increasing the number of people living with and dying from advanced serious illnesses globally. Many of these people are hospitalised more than once in their last year of life. While there is sound evidence on what pati...
| Publicado en: | BMC Palliative Care Vol. 24; no. 1; pp. 1 - 17 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
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BioMed Central
7/2/2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=186335863&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 186335863 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 1472684X 1CID jtl: BMC Palliative Care issn: 1472684X maglogo: N pubinfo: dt: 7/2/2025 vid: 24 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 186335863 186335863 186335863 10.1186/s12904-025-01815-1 186335863 ppf: 1 ppct: 16 formats: tig: atl: Understanding the acute care context to inform palliative care improvements: a qualitative study of hospital-based multidisciplinary clinicians. aug: au: Virdun, Claudia Singh, Gursharan K. Yates, Patsy Phillips, Jane L. Mudge, Alison affil: https://ror.org/01kpzv902 Palliative & End of Life Care, College of Nursing and Health Sciences, and member, Flinders Research Centre for Palliative Care, Death, and Dying, Flinders University, Adelaide, SA, Australia sug: subj: Quality Improvement Palliative Care Acute Care Attitude of Health Personnel Evaluation Multidisciplinary Care Team Hospitals Australia Human Hospitals, Urban Exploratory Research Descriptive Research Qualitative Studies Semi-Structured Interview Thematic Analysis Male Female Leadership Clinical Competence Education Confidence Tertiary Health Care Audiorecording Interview Guides Academic Medical Centers Male Female ab: Background: Population ageing and rising levels of non-communicable diseases are increasing the number of people living with and dying from advanced serious illnesses globally. Many of these people are hospitalised more than once in their last year of life. While there is sound evidence on what patients and their families require for safe and high-quality hospital palliative care, enabling this remains a challenge. This study aimed to understand the clinician, team, and organisational-level barriers and enablers to integrating good palliative care into acute care. Methods: An exploratory-descriptive, qualitative study involving semi-structured interviews and practical thematic analysis was conducted. Medical, nursing and allied health disciplines were recruited from three wards (cancer care, mixed general medicine/renal and mixed general medicine/respiratory) within a large Australian metropolitan hospital. Results: Eighty-eight interviews (nursing (n = 39); medicine (n = 24); allied health (n = 25)) were undertaken, with a median duration of 25.5 min (range 5 to 55 min). Most participants were female (n = 73, 83%), holding a Bachelor's degree (n = 86, 98%) and ranged from new graduates to participants with over 40 years of post-registration experience. The analysis generated six themes, reflecting the challenges of providing optimal palliative care within acute hospital wards: 1. Understanding when and how to provide palliative care 2. Negotiating shared or changing medical governance in a siloed system 3. Supporting clinicians with the knowledge, skills and confidence to meet palliative care needs 4. Prioritising palliative care amidst the acute care demands of the hospital 5. Optimising the clinical environment to enable private, restful and family-friendly spaces 6. Harnessing organisational support and multidisciplinary clinical leadership Conclusions: This study reveals complex, multi-level organisational barriers to integrating palliative care within the acute hospital which will need to be addressed for effective and sustained improvement. Harnessing organisational support and multidisciplinary clinical leadership is key to successful change. Improvements with a focus on developing clinician knowledge, skills, and confidence in palliative care need to pay attention to organisational siloes that constrain shared care, cultures of care that prioritise cure and efficiency, clinical uncertainty in the context of advanced serious illness and optimising the environment for quality palliative care. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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