Improving the organization of palliative care: identification of barriers and facilitators in five European countries

Implementation Science

Yvonne Engels⁶  Kris Vissers⁶  Ragni Sommerbakk⁸  Elena Mariani⁴  Birgit Jaspers⁵  Wojciech Leppert¹  Nathan Davies⁹  Steve Iliffe⁹  Franka Meiland²  Frederike Brouwer⁷  Myrra Vernooij-Dassen³  Jasper van Riet Paap⁷ 

[1] Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245, Poznan, Poland;Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, Alzheimer Center, VU University Medical Center, Amsterdam, 1007 MB, The Netherlands;Kalorama Foundation, Nijmegen, The Netherlands;Alma Mater Studiorum, Department of Psychology, University of Bologna, Bologna, Italy;Clinic for Palliative Medicine, University of Goettingen, Robert-Koch-Str. 40, Goettingen, 37075, Germany;Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands;Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, 6500 HB, The Netherlands;European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway;Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK

关键词: Europe;    Organization of care;    Quality improvement;    Barriers and facilitators;    Palliative care;   

Others  :  1139507
DOI  :  10.1186/s13012-014-0130-z

 received in 2014-05-30, accepted in 2014-09-19,  发布年份 2014

【 摘 要 】

Background

Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care¿s complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service.

Methods

Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data.

Results

Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries.

Conclusion

This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.

【 授权许可】

   
2014 van Riet Paap et al.; licensee BioMed Central Ltd.

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