Structure and integration of specialty palliative care in three NCI-designated cancer centers: a mixed methods case study

BMC Palliative Care

Research

Gabriel A. Brooks¹  Nirav S. Kapadia¹  Garrett T. Wasp¹  Kristin E. Knutzen²  Genevra F. Murray³  Karen E. Schifferdecker⁴  Rebecca L. Butcher⁴  Amanda N. Perry⁴  Amber E. Barnato⁴  Gabrielle B. Rocque⁵  Laura C. Hanson⁶  Susan Eggly⁷ 

[1] Dartmouth Health Department of Medicine, One Medical Center Drive, 03756, Lebanon, NH, USA;Emory Rollins School of Public Health, 1518 Clitton Rd. NE, 30322, Atlanta, GA, USA;New York University School of Global Public Health, 708 Broadway, 10003, New York, NY, USA;The Dartmouth Institute for Health Policy and Clinical Practice at Geisel School of Medicine, Dartmouth College, WTRB Level 5, 1 Medical Center Drive, 03756, Lebanon, NH, USA;University of Alabama at Birmingham, 500 Second Street South, 35233, Birmingham, AL, USA;University of North Carolina-Chapel Hill School of Medicine, 5003 Old Clinic, CB# 7550, 27599, Chapel Hill, NC, USA;Wayne State University School of Medicine, Karmanos Cancer Institute, Mid-Med Lofts, Suite 3000, 87 E Canfield, 48201, Detroit, MI, USA;

关键词: Specialty palliative;    Care integration;   

DOI  :  10.1186/s12904-023-01182-9

 received in 2022-11-23, accepted in 2023-05-04,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionEarly access to specialty palliative care is associated with better quality of life, less intensive end-of-life treatment and improved outcomes for patients with advanced cancer. However, significant variation exists in implementation and integration of palliative care. This study compares the organizational, sociocultural, and clinical factors that support or hinder palliative care integration across three U.S. cancer centers using an in-depth mixed methods case study design and proposes a middle range theory to further characterize specialty palliative care integration.MethodsMixed methods data collection included document review, semi-structured interviews, direct clinical observation, and context data related to site characteristics and patient demographics. A mixed inductive and deductive approach and triangulation was used to analyze and compare sites’ palliative care delivery models, organizational structures, social norms, and clinician beliefs and practices.ResultsSites included an urban center in the Midwest and two in the Southeast. Data included 62 clinician and 27 leader interviews, observations of 410 inpatient and outpatient encounters and seven non-encounter-based meetings, and multiple documents. Two sites had high levels of “favorable” organizational influences for specialty palliative care integration, including screening, policies, and other structures facilitating integration of specialty palliative care into advanced cancer care. The third site lacked formal organizational policies and structures for specialty palliative care, had a small specialty palliative care team, espoused an organizational identity linked to treatment innovation, and demonstrated strong social norms for oncologist primacy in decision making. This combination led to low levels of specialty palliative care integration and greater reliance on individual clinicians to initiate palliative care.ConclusionIntegration of specialty palliative care services in advanced cancer care was associated with a complex interaction of organization-level factors, social norms, and individual clinician orientation. The resulting middle range theory suggests that formal structures and policies for specialty palliative care combined with supportive social norms are associated with greater palliative care integration in advanced cancer care, and less influence of individual clinician preferences or tendencies to continue treatment. These results suggest multi-faceted efforts at different levels, including social norms, may be needed to improve specialty palliative care integration for advanced cancer patients.

【 授权许可】

CC BY   
© The Author(s) 2023

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