The ‘problematisation’ of palliative care in hospital: an exploratory review of international palliative care policy in five countries

BMC Palliative Care

Research Article

Merryn Gott¹  Jackie Robinson²  Clare Gardiner³  Christine Ingleton³ 

[1] Auckland District Health Board, Auckland, New Zealand;School of Nursing, University of Auckland, Auckland, New Zealand;Auckland District Health Board, Auckland, New Zealand;School of Nursing, University of Sheffield, Sheffield, UK;

关键词: Palliative care;    Policy;    Hospital;   

DOI  :  10.1186/s12904-016-0137-0

 received in 2016-03-17, accepted in 2016-06-16,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundGovernment policy is a fundamental component of initiating change to improve the provision of palliative care at a national level. The World Health Organisation’s recognition of palliative care as a basic human right has seen many countries worldwide develop national policy in palliative and end of life care. There is increasing debate about what form comprehensive palliative care services should take, particularly in relation to the balance between acute and community based services. It is therefore timely to review how national policy positions the current and future role of the acute hospital in palliative care provision. The aim of this exploratory review is to identify the role envisaged for the acute hospital in palliative and end of life care provision in five countries with an ‘advanced’ level of integration.MethodCountries were identified using the Global Atlas of Palliative Care. Policies were accessed through internet searching of government websites between October and December 2014. Using a process of thematic analysis key themes related to palliative care in hospital were identified.ResultsPolicies from Switzerland, England, Singapore, Australia and Ireland were analysed for recurring themes. Three themes were identified: preferences for place of care and place of death outside the hospital setting, unnecessary or avoidable hospital admissions, and quality of care in hospital. No policy focused upon exploring how palliative care could be improved in the hospital setting or indeed what role the hospital may have in the provision of palliative care.ConclusionsPalliative care policy in five countries with ‘advanced’ levels of palliative care integration focuses on solving the ‘problems’ associated with hospital as a place of palliative care and death. No positive role for hospitals in palliative care provision is envisaged. Given the rapidly increasing population of people requiring palliative care, and emerging evidence that patients themselves report benefits of hospital admissions, this area requires further investigation. In particular, a co-design approach to policy development is needed to ensure that services match the needs and wants of patients and families.

【 授权许可】

CC BY   
© The Author(s). 2016