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Borgstrom, Erica; Schiff, Rebekah; Khan, Shaheen; Hindley, Esther; Thayabaran, Darmiga; Savage, Emily; Gough, Nicholas and Holti, Richard
(2024).
DOI: https://doi.org/10.12688/healthopenres.13534.1
URL: https://healthopenresearch.org/articles/6-12
Abstract
Introduction
With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow.
Methods
An exploratory qualitative interview study was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice.
Results
Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a detrimental effect on their care or needs.
Conclusions
There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life.
Plain Language Summary
There is a need for geriatric and palliative care teams to work together. How they have done this so far has developed over time, but little is documented about how they work together. We conducted interviews at a large London hospital to look at end-of-life care for older persons. 30 staff, who worked either in palliative care or geriatric teams, were interviewed as were two patients and five carers. Interview questions asked about collaboration and how care was provided. Researchers identified themes in the interviews, looking for examples of successful collaboration, areas of tension or confusion, and suggestions for future changes. Interviewees were positive about collaboration, especially when it came to referring to palliative care and communication about specific patients. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a negative effect on them. There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. More research in this area is needed to inform national guidelines and policy.
CORE (COnnecting REpositories)
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