The online version of this article (https://doi.org/10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care.
Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings.
The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care.
Complexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life.
Additional file 1: Defining complexity in palliative care – Topic guide for interviews. (DOC 26 kb)12904_2017_259_MOESM1_ESM.doc
Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives. Guidance document published collaboratively with Association for Palliative Medicine of Great Britain and Ireland; Consultant Nurse in Palliative Care Reference Group; Marie Curie Cancer Care; National Council for Palliative Care and Palliative Care Section of the Royal Society of Medicine. London; 2012.
Weissman DM. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the center to advance palliative care. J Palliat Med. 2011;14(1):2–7. CrossRef
Mitchell GKJ, Thomas K, Murray SA. Palliative care beyond that for cancer in Australia. Med J Aust. 2010;193(2):124–6. PubMed
WHO Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Accessed 20 Dec 16.
McIlfatrick S. Assessing palliative care needs: views of patients, informal carers and healthcare professionals. J AdvNurs. 2007;57(1):77–86.
National End of Life Care Intelligence Network: Variations in place of death in England: inequalities or appropriate consequences of age, gender and cause of death? 2010.
Higginson IJ, Sen-Gupta GJ. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. JPalliatMed. 2000;3(3):287–300.
Gomes BC, Calanzani N; Higginson, I: Local preferences and place of death in regions within England. 2011.
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014;4(3) 285-90.
Supportive & Palliative Care Indicators Tool (SPICT™) http://www.spict.org.uk/. Accessed 20 Dec 16.
O’Callaghan A, Laking G, Frey R, Robinson J, Gott M. Can we predict which hospitalised patients are in their last year of life? A prospective cross-sectional study of the Gold Standards Framework Prognostic Indicator Guidance as a screening tool in the acute hospital setting. Palliat Med. 2014;28 (3):1046-52.
Harding J. Qualitative data analysis from start to finish. London: Sage; 2013.
Miles MB, Huberman AM. Qualitative data analysis: an expanded source book. Thousand Oaks: Sage; 1994.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. CrossRef
Buckley CA, Waring MJ. Using diagrams to support the research process: examples from grounded theory. Qual Res. 2013;13(2):148–72. CrossRef
Ewing G, Farquhar M, Booth S. Delivering palliative care in an acute hospital setting: views of referrers and specialist providers. J Pain Symptom Manag. 2009;38(3):327–40. CrossRef
Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. J Pain Symptom Manag. 2007;34(4):393–402. CrossRef
- What does ‘complex’ mean in palliative care? Triangulating qualitative findings from 3 settings
Scott A. Murray
- BioMed Central
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