A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings

Abstract

Background:

Individuals with palliative care needs face increased risk of discontinuity of care as they navigate between healthcare settings, locations and practitioners which can result in poor outcomes. Little is known about interactions that occur between specialist and generalist palliative care teams as patients are transition from hospital to community-based care after hospitalisation.

Aim:

To understand what happens between inpatient specialist palliative care teams and the generalist teams who provide post-discharge palliative care for shared patients.

Design:

A constructivist grounded theory approach, using semi-structured interviews and constant comparative analysis, including coding, memo-writing and diagram construction.

Settings/participants:

Interviews (n = 21) with specialist palliative care clinicians and clinicians in other specialties providing generalist palliative care. Specialists had training in palliative care and worked in specialty palliative care practices; other clinicians worked in primary care or oncology and did not have specialised palliative care training.

Results:

A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings was constructed. Two states of inter-team functioning were found which related to how teams perceived themselves: separate teams or one cross-boundary team. Three conditions influenced these two states of inter-team functioning: knowing the other team; communicating intentionally; and acknowledging and valuing the role of the other team.

Conclusions:

Teams need to explicitly consider and agree their mode of functioning, and enact changes to enhance knowledge of the team, intentional communication and valuing other teams’ contributions. Future research is needed to test or expand this theory across a range of cultures and contexts.

Keywords

Palliative care interdisciplinary health team interprofessional relations continuity of patient care grounded theory qualitative research

Get full access to this article

View all access options for this article.

References

World Health Organization and Worldwide Palliative Care Alliance. Global atlas of palliative care at end of life 2014. London: Worldwide Palliative Care Alliance.

Bähler

Signorell

Reich

Health care utilisation and transitions between health care settings in the last 6 months of life in Switzerland. PLoS One 2016; 11: e0160932.

Wang

Aldridge

Gross

, et al. End-of-life care transition patterns of medicare beneficiaries. J Am Geriatr Soc 2017; 65: 1406–1413.

Van den Block

Pivodic

Pardon

, et al. Transitions between health care settings in the final three months of life in four EU countries. Eur J Public Health 2015; 25: 569–575.

Graham

Ivey

Neuhauser

From hospital to home: assessing the transitional care needs of vulnerable seniors. Gerontologist 2009; 49: 23–33.

World Health Organization. Transitions of care: technical series on safer primary care. Geneva: World Health Organization, 2016.

Haggerty

Reid

Freeman

, et al. Continuity of care: a multidisciplinary review. BMJ 2003; 327: 1219.

Davis

Devoe

Kansagara

, et al. “Did I do as best as the system would let me?” Healthcare professional views on hospital to home care transitions. J Gen Intern Med 2012; 27: 1649–1656.

Munday

Boyd

Jeba

, et al. Defining primary palliative care for universal health coverage. Lancet 2019; 394: 621–622.

10.

Arias-Casais

Garralda

Rhee

, et al. EAPC Atlas of palliative care in Europe 2019. Vilvoorde: EAPC Press, 2019.

11.

Kirby

Broom

Good

, et al. Medical specialists’ motivations for referral to specialist palliative care: a qualitative study. BMJ Support Palliat Care 2014; 4: 277.

12.

Firn

Preston

Walshe

Ward social workers’ views of what facilitates or hinders collaboration with specialist palliative care team social workers: a grounded theory. BMC Palliat Care 2017; 17: 7.

13.

Ewing

Farquhar

Booth

Delivering palliative care in an acute hospital setting: views of referrers and specialist providers. J Pain Symptom Manag 2009; 38: 327–340.

14.

McCaughan

Roman

Smith

, et al. Palliative care specialists’ perceptions concerning referral of haematology patients to their services: findings from a qualitative study. BMC Palliat Care 2018; 17: 11.

15.

Aitken

District nurses’ triggers for referral of patients to the Macmillan nurse. Br J Community Nurs 2006; 11: 100–104.

16.

Wright

Forbes

Haematologists’ perceptions of palliative care and specialist palliative care referral: a qualitative study. BMJ Support Palliat Care 2014; 7: 39–45.

17.

Dudley

Ritchie

Rehm

, et al. Facilitators and barriers to interdisciplinary communication between providers in primary care and palliative care. J Palliat Med 2019; 22: 243–249.

18.

Walshe

Todd

Caress

, et al. Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study. Br J Gen Pract 2008; 58: 264–272.

19.

Albers

Froggatt

Van den Block

, et al. A qualitative exploration of the collaborative working between palliative care and geriatric medicine: barriers and facilitators from a European perspective. BMC Palliat Care 2016; 15: 10.

20.

Markey

Tilki

Taylor

Reflecting on the challenges of choosing and using a grounded theory approach. Nurse Res 2014; 22: 16–22.

21.

Thornberg

Informed grounded theory. Scand J Educ Res 2012; 56: 243–259.

22.

Charmaz

Constructing grounded theory. 2nd ed. London: Sage, 2014.

23.

Engward

Understanding grounded theory. Nurs Stand 2013; 28: 37–41.

24.

Harris

Grounded theory. Nurs Stand 2015; 29: 32–39.

25.

Higginbottom

Lauridsen

EI.

The roots and development of constructivist grounded theory. Nurse Res 2014; 21: 8–13. DOI: 10.7748/nr.21.5.8.e1208.

26.

QSR International. NVIVO, https://www.qsrinternational.com/nvivo/home (2019, accessed 25 May 2019).

27.

Speziale

Carpenter

Qualitative research in nursing: advancing the humanistic imperative. Philadelphia, PA: Lippincott Williams and Wilkins, 2003.

28.

Glaser

The grounded theory perspective: conceptualization contrasted with description. Mill Valley, CA: Sociology Press, 2001.

29.

Kühnen

Oyserman

Thinking about the self influences thinking in general: cognitive consequences of salient self-concept. J Exp Soc Psychol 2002; 38: 492–499.

30.

Gardner

Gabriel

Lee

AY.

“I” value freedom, but “we” value relationships: self-construal priming mirrors cultural differences in judgment. Psychol Sci 1999; 10: 321–326.

31.

Oyserman

Lee

SWS

. Does culture influence what and how we think? Effects of priming individualism and collectivism. Psychol Bull 2008; 134: 311–342.

32.

McAtavey

Nikolovska

Team collectivist culture: a remedy for creating team effectiveness. Hum Resour Dev Quart 2010; 21: 307–316.

33.

Gerpott

Balliet

Columbus

, et al. How do people think about interdependence? A multidimensional model of subjective outcome interdependence. J Pers Soc Psychol 2018; 115: 716–742.

34.

Abu

Anatchkova

Erskine

, et al. Are we “missing the big picture” in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization. Appl Nurs Res 2018; 44: 60–66.

35.

Acosta

Camara

Weber

LAF

, et al. Nurses’ activities in care transition: realities and challenges. J Nurs UFPE OnLine 2018; 12: 3190–3197.

36.

Bull

Roberts

Components of a proper hospital discharge for elders. J Adv Nurs 2001; 35: 571–581.

37.

Johnson

Farnan

Barach

, et al. Searching for the missing pieces between the hospital and primary care: mapping the patient process during care transitions. BMJ Qual Saf 2012; 21 Suppl 1: i97–i105.

38.

van der Plas

AGM

Hagens

Pasman

HRW

, et al. PaTz groups for primary palliative care: reinventing cooperation between general practitioners and district nurses in palliative care: an evaluation study combining data from focus groups and a questionnaire. BMC Fam Pract 2014; 15: 7.

39.

Firn

Preston

Walshe

What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams? A systematically constructed narrative synthesis. Palliat Med 2016; 30: 240–256.

40.

Thelen

Transitions in palliaitve care provision across healthcare settings in the U.S.: a grounded theory of interdependence between specialist and generalist palliative care teams. Lancaster University, United Kingdom, 2020.

41.

Alazri

Heywood

Neal

, et al. Continuity of care: literature review and implications. Sultan Qaboos Univ Med J 2007; 7: 197–206.

42.

Saultz

JW.

Defining and measuring interpersonal continuity of care. Ann Fam Med 2003; 1: 134–143.

43.

Guraya

Barr

The effectiveness of interprofessional education in healthcare: a systematic review and meta-analysis. Kaohsiung J Med Sci 2018; 34: 160–165.

44.

Xyrichis

Reeves

Zwarenstein

Examining the nature of interprofessional practice: an initial framework validation and creation of the InterProfessional Activity Classification Tool (InterPACT). J Interprof Care 2018; 32: 416–425.

45.

Charmaz

Thornberg

The pursuit of quality in grounded theory. Qual Res Psychol 2021; 18: 305–327.

46.

Kamal

AH.

“Who does what?” Ensuring high-quality and coordinated palliative care with our oncology colleagues. J Pain Symptom Manag 2016; 52: E1–E2.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.13 MB