7 research outputs found
A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers
What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings
Background: Complex need for patients with a terminal illness distinguishes those who would benefit from
specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is
not well defined or understood. This study describes how health professionals, from three distinct settings in the United
Kingdom, understand complex need in palliative care.
Methods: Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice
settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data
collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings
across settings.
Results: The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms
and complicated social and psychological issues increased perceived complexity. Poor communication between patients
and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’
and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional
development in palliative care.
Conclusions: Complexity in the context of palliative care can be inherent to the patient or perceived by health
professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but
are amenable to change by training in identifying, prognosticating for, and communicating with patients
approaching the end of life