Improving the organization of palliative care: identification of barriers and facilitators in five European countries
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RESEARCH
Open Access
Improving the organization of palliative care: identification of barriers and facilitators in five European countries Jasper van Riet Paap1*, Myrra Vernooij-Dassen1,2, Frederike Brouwer1, Franka Meiland3, Steve Iliffe4, Nathan Davies4, Wojciech Leppert5, Birgit Jaspers6,7, Elena Mariani8, Ragni Sommerbakk9, Kris Vissers10, Yvonne Engels10, on behalf of the IMPACT research team
Abstract 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. Keywords: Palliative care, Barriers and facilitators, Quality improvement, Organization of care, Europe
Background Palliative care aims to preserve the best possible quality of life of the patient whose disease is not responsive to curative treatment [1]. Improvements in palliative care usually focus on pain and symptom control, use of standardized assessment tools, care in the last days of life and the quality of dying [2,3]. To date, improving specific organizational aspects of palliative care has received less attention [3].
* Correspondence: [email protected] 1 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands Full list of author information is available at the end of the article
Interventions to improve the organization of palliative care encounter challenges beyond the usual problems of implementation of change in health care. Patients in need of palliative care often move between services, have
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