The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

Abstract Acute care and palliative care are described as different incompatible organisational care cultures, with contrasts and contradictions. Few studies have observed the actual meeting between these two cultures. Purpose: To study the meeting and interaction of two different organisational care cultures, palliative care and curative acute wards, when a palliative care consultation team introduces consulting services to acute wards regarding end-of-life palliative care. Methods: An ethnographic study design was used, including observations, interviews and diary entries. A palliative care consultation team visited surgical and internal medicine wards during one year. An integrative bedside education approach was used, where physicians and nurses experienced in PC tried to embed PC principles and interventions into daily practice. The analysis was inspired by Spradley’s ethnography.Results: Three themes were found in the study: 1) Values, illusions, and wording in the acute care culture; 2) Didactic challenges and strategies, and 3) The palliative illusion becomes a fusion. On the acute wards, fast “turn over” was the goal of care: to treat patients quickly and send them home. Primary health care team members believed that they gave dying patients good care, a conclusion not supported by the palliative care team, who identified values problems and a knowledge shortage among all primary team members. Because the primary team did not have time for reflection regarding patients’ whole situation, and wanted to do as much as possible before “giving up”, their patients could be one hour from death before the primary team provided palliative care. After one year, primary team members wanted the palliative care consultation team to continue, since they felt they could not handle dying patients on their own.Conclusion: Palliative care consultation team make changes about end- of- life care when working with primary health care team members on acute wards. The didactic challenges are many and require efforts.

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Cultures that collide: an ethnographic study of the introduction of a palliative care consultation team on acute wards

BMC Palliative Care ◽

10.1186/s12904-021-00877-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Maria Friedrichsen ◽

Yvonne Hajradinovic ◽

Maria Jakobsson ◽

Kerstin Brachfeld ◽

Anna Milberg

Keyword(s):

Palliative Care ◽

Acute Care ◽

Intervention Study ◽

Daily Practice ◽

Ethnographic Study ◽

Consulting Services ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation ◽

Acute Wards

Abstract Background Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. Purpose To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. Methods An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. Results Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. Conclusion There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.

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Palliative care consultation team on acute wards—an intervention study with pre-post comparisons

Supportive Care in Cancer ◽

10.1007/s00520-016-3406-9 ◽

2016 ◽

Vol 25 (2) ◽

pp. 371-380 ◽

Cited By ~ 5

Author(s):

Maria Friedrichsen ◽

Yvonne Hajradinovic ◽

Maria Jakobsson ◽

Per Milberg ◽

Anna Milberg

Keyword(s):

Palliative Care ◽

Intervention Study ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation ◽

Acute Wards

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Perceptions of Specialty Palliative Care and Its Role in Pediatric Stem Cell Transplant: A Multi-Disciplinary Qualitative Study

10.22541/au.162284190.02520988/v1 ◽

2021 ◽

Author(s):

Griffin Collins ◽

Hannah Beaman ◽

Alvin Ho ◽

Michelle Hermiston ◽

Harvey Cohen ◽

...

Keyword(s):

Palliative Care ◽

Stem Cell ◽

Stem Cell Transplant ◽

Palliative Care Team ◽

Care Team ◽

Cell Transplant ◽

Team Members ◽

Care Integration ◽

Palliative Care Consultation ◽

Care Consultation

Background Consultation of specialty palliative care remains uncommon in pediatric stem cell transplant (SCT) despite growing evidence that early integration of palliative care improves outcomes in patients with advanced cancers or undergoing SCT. Little is known about how multidisciplinary pediatric SCT teams perceive palliative care and its role in SCT. Procedure We conducted semi-structured interviews of members of a multi-disciplinary SCT team to understand their perceptions of palliative care, how specialty palliative care is integrated into SCT, and to identify barriers to increased integration. Eligible participants included physicians, nurses, nurse practitioners, social workers, and child life specialists. Data was analyzed using thematic analysis. Results Four major themes were identified. First, SCT team members held a favorable perception of the palliative care team. Second, participants desired increased palliative care integration in SCT. Third, participants believed that the palliative care team had insufficient resources to care for the large number of SCT patients which led to the SCT team limiting palliative care consultation. And, finally, the lack of a standardized palliative care consultation process prevented greater integration of palliative care in SCT. Conclusions SCT team members held a favorable perception of palliative care and saw a role for greater palliative care integration throughout the SCT course. We identified modifiable barriers to greater palliative care integration. SCT teams who desire greater palliative care integration may adapt and implement an existing model of palliative care integration in order to improve standardization and increase integration of specialty palliative care in SCT.

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Barriers and Facilitators to Effective Inpatient Palliative Care Consultations: A Qualitative Analysis of Interviews With Palliative Care and Nonpalliative Care Providers

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118793635 ◽

2018 ◽

Vol 36 (3) ◽

pp. 191-199 ◽

Cited By ~ 3

Author(s):

Meghan McDarby ◽

Brian D. Carpenter

Keyword(s):

Palliative Care ◽

Nurse Practitioners ◽

Care Service ◽

Palliative Care Service ◽

Educational Interventions ◽

Care Providers ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation ◽

Successful Collaboration

Objective: To identify factors that hinder or facilitate the palliative care consultation team’s (PCCT) successful collaboration with other providers from the perspectives of both PCCT and nonpalliative specialists. Methods: Qualitative study, including semistructured interviews with PCCT and nonpalliative care providers from various specialties at 4 Midwestern hospitals. Interviews were audio-recorded and transcribed into written text documents for thematic analysis. Palliative care consultation team (n = 19) and nonpalliative care providers (n = 29) were interviewed at their respective hospital sites or via telephone. Palliative care consultation team providers included physicians, nurse practitioners, registered nurses, social workers, and one chaplain. Specialists included critical care physicians, surgeons, hospitalists, nephrologists, oncologists, and cardiologists. Results: Six themes emerged reflecting barriers to and facilitators of successful collaboration between the PCCT and other providers. Primary barriers included attitudes about palliative care, lack of knowledge about the role of the PCCT, and patient and family resistance. Facilitators included marketing of the palliative care service and education about the expertise of the PCCT. Conclusion: In order to engage in more effective collaboration with other specialty providers, the PCCT may consider strategies including structured educational interventions, increased visibility in the hospital, and active marketing of the utility of palliative care across disciplines.

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Talking with families and children about the death of a parent

10.1093/med/9780199656097.003.0062 ◽

2015 ◽

Author(s):

Mari Lloyd-Williams ◽

Jackie Ellis

Keyword(s):

Palliative Care ◽

Conflict Management ◽

Interprofessional Communication ◽

Team Members ◽

Good Communication ◽

Palliative Care Consultation ◽

Death Of A Parent ◽

Care Consultation ◽

Provider Outcomes ◽

Structured Communication

Patient and provider outcomes are significantly related to the effectiveness of interprofessional communication Good interprofessional communication includes adopting an attitude of curiosity, recognizing that communication happens at several levels simultaneously, and acknowledging the importance of skilful conflict management. Barriers to good communication among interdisciplinary team members include team organization, provider hierarchy, and professional identity. Optimal communication among palliative consultants and other clinicians requires expert consultation etiquette, and overcoming particular challenges faced by palliative care consultants including the high emotion often accompanying palliative care consultations and the often contrasting assessment of the patient’s needs by the consulting and referring clinicians. The chapter describes how to use structured communication tools, designated forums for discussion, flattened hierarchy, and an open, no-fault culture, along with five core principles for good communication in palliative care consultation: curiosity, humility, transparency, clarity, and judiciousness. Palliative care plays a key role in optimizing interprofessional communication.

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Validation of the Palliative Prognostic Index and Palliative Prognostic Score in a Palliative Care Consultation Team Setting for Patients With Advanced Cancers in an Acute Care Hospital in Japan

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909113506034 ◽

2013 ◽

Vol 31 (7) ◽

pp. 730-734 ◽

Cited By ~ 7

Author(s):

Hiroshi Sonoda ◽

Takashi Yamaguchi ◽

Mina Matsumoto ◽

Ko Hisahara

Keyword(s):

Palliative Care ◽

Prognostic Score ◽

Prognostic Index ◽

Acute Care Hospital ◽

Care Hospital ◽

Palliative Care Consultation ◽

Palliative Prognostic Index ◽

Consultation Team ◽

Care Consultation ◽

Team Setting

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A new palliative care consultation team at the oncology department of a university hospital: an assessment of initial efficiency and effectiveness

Supportive Care in Cancer ◽

10.1007/s00520-012-1476-x ◽

2012 ◽

Vol 20 (9) ◽

pp. 2199-2203 ◽

Cited By ~ 21

Author(s):

Ana de Santiago ◽

María Angustias Portela ◽

Luis Ramos ◽

Ana Larumbe ◽

Julia Urdiroz ◽

...

Keyword(s):

Palliative Care ◽

University Hospital ◽

Palliative Care Consultation ◽

Efficiency And Effectiveness ◽

Consultation Team ◽

Care Consultation

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Evaluating the impact of early versus late inpatient palliative care consultation for cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6638 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6638-6638

Author(s):

Brian Cassel ◽

Patrick J. Coyne ◽

Nevena Skoro ◽

Kathleen Kerr ◽

Egidio Del Fabbro

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Palliative Care Team ◽

Care Team ◽

Care Hospital ◽

Palliative Care Consultation ◽

Social Security Death Index ◽

Hospital Deaths ◽

Care Consultation ◽

The Impact

6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]

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