Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents.
Method
A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium.
Results
Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation.
Discussion
The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
LynnJForliniJH.“Serious and complex illness” in quality improvement and policy reform for end-of-life care. J Gen Intern Med2001;
16: 315–319.
3.
FroggattKWilsonDJusticeCet al.
End-of-life care in long-term care settings for older people: a literature review. Int J Old People Nurs2006;
1: 45–50.
4.
RoenISelbaekGKirkevoldOet al.
Resourse use and disease couse in dementia-nursing home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes. BMC Health Serv Res2017;
17: 365.
5.
AtramontARigaultAChevalierSet al.
Characteristics, diseases and mortality of people admitted to nursing homes for dependent seniors during the first quarter of 2013 in France. Revue D Epidemiol Sante Publ2017;
65: 221–230.
6.
Van RensbergenGNawrotT.Medical conditions of nursing home admissions. BMC Geriatr2010;
10: 9.
7.
CondeliusAAnderssonM.Exploring access to care among older people in the last phase of life using the behavioural model of health services use: a qualitative study from the perspective of the next of kin of older persons who had died in a nursing home. BMC Geriatr2015;
15: 14.
8.
JonssonLEriksdotter JonhagenMKilanderLet al.
Determinants of costs of care for patients with Alzheimer's disease. Int J Geriat Psychiatry2006;
21: 449–459.
9.
LiSMiddletonAOttenbacherKJet al.
Trajectories over the first year of long-term care nursing home residence. J Am Med Dir Assoc2018;
19: 333–341.
10.
ConsortiumM.Palliatieve zorg en euthanasie in belgië. Evaluatie van de praktijk en de wetten.
Brussel:
Uitgeverij ASP (Academic Scientific Publishers), 2011.
11.
FroggattKPayneS.A survey of end-of-life care in care homes: issues of definition and practice. Health Soc Care Commun2006;
14: 341–348.
12.
KinleyJHockleyJStoneLet al.
The provision of care for residents dying in UK nursing care homes. Age Age2014;
43: 375–379.
13.
BadgerFPlumridgeGHewisonAet al.
An evaluation of the impact of the Gold Standards Framework on collaboration in end-of-life care in nursing homes. A qualitative and quantitative evaluation. Int J Nurs Stud2012;
49: 586–595.
14.
Van RensbergenGNawrotTSVan HeckeEet al.
Where do the elderly die? The impact of nursing home utilisation on the place of death. Observations from a mortality cohort study in Flanders. BMC Public Health2006;
6:178.
15.
Van Den BlockLPivodicLPardonKet al.
Transitions between health care settings in the final three months of life in four EU countries. Eur J Public Health2015;
25: 569–575.
16.
BainbridgeDSeowHSussmanJet al.
Factors associated with acute care use among nursing home residents dying of cancer: a population-based study. Int J Palliat Nurs2015;
21: 349–356.
17.
De GendtCBilsenJVander SticheleRet al.
Advance care planning and dying in nursing homes in Flanders, Belgium: a nationwide survey. J Pain Symptom Manage2013;
45: 223–234.
18.
FlemingJZhaoJFarquharMet al.
Place of death for the ‘oldest old': >= 85-year-olds in the CC75C population-based cohort. Br J General Pract2010;
60: 171–179.
19.
HasselaarJPayneS.Moving the integration of palliative care from idea to practice. Palliat Med2016;
30: 197–199.
20.
HasselaarJPayneS.Integrated palliative care – InSup-C.
Nijmegen:
Radboud University Center, 2016.
21.
GarraldaEHasselaarJCarrascoJMet al.
Integrated palliative care in the Spanish context: a systematic review of the literature. BMC Palliat Care2016;
15: 17.
22.
Van der SteenJTRadbruchLCeesHMet al.
White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med2014;
28: 197–209.
23.
KodnerDSpreeuwenbergC.Integrated care: meaning, logic, applications, and implications – a discussion paper. Int J Integr Care2002;
2: 1–6.
24.
KodnerDL.All together now: a conceptual exploration of integrated care. Healthc Q2009;
13: 6–15.
25.
PoppJKMilwardBHMcKeanGet al. Inter-organizational networks: a review of the literature to inform practice. Report for Alberta Centre for Child, Family and Community Research. Available from: http://www.businessofgovernment.org/
26.
DudgeonDVaitonisVSeowHet al.
Ontario, Canada: using networks to integrate palliative care province-wide. J Pain Symptom Manage2007;
33: 640–644.
27.
De SandeC-VDer RijtCVisserAPet al.
Function of local networks in palliative care: a Dutch view. J Palliat Med2005;
8: 808–816.
28.
TravisSHuntP.Supportive and palliative care networks: a new model for integrated care. Int J Palliat Nurs2001;
7: 501–504.
29.
van RaakAPaulusACuijpersRet al.
Problems of integrated palliative care: a Dutch case study of routines and cooperation in the region of Arnhem. Health Place2008;
14: 768–778.
30.
ThomsonAMPerryJLMillerTK.Conceptualizing and measuring collaboration. J Pub Administrat Res Theory Adv Access2007;
19: 23–59.
31.
KaramMBraultIVan DurmeTet al.
Comparing interprofessional and interorganizational collaboration in healthcare: a systematic review of the qualitative research. Int J Nurs Stud2018;
79: 70–83.
32.
AuschraC.Barriers to the integration of care in inter-organisational settings: a literature review. Int J Integr Care2018;
18: 14.
33.
FirnJPrestonNWalsheC.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 Med2016;
30: 240–256.
34.
BainbridgeDBrazilKKruegerPet al.
Measuring horizontal integration among health care providers in the community: an examination of a collaborative process within a palliative care network. J Interprof Care2015;
29: 245–252.
35.
JansenWJJPerezRZuurmondWWAet al.
Networks for palliative care in the Netherlands: the pioneer phase beyond?J Palliat Med2011;
14: 266–267.
36.
CollinsKMTOnwuegbuzieAJJiaoQG.A mixed methods investigation of mixed methods sampling designs in social and health science research. J Mix Methods Res2007;
1: 267–294.
37.
Federatie Palliatieve Zorg Vlaanderen. Wat is een netwerk palliatieve zorg, www.palliatief.be/netwerken (accessed 9 May 2017).
38.
FrickerRD.Sampling methods for web and e-mail surveys. In: FieldingNLeeRMBlankG (eds) The SAGE handbook of online research methods.
Newbury, CA:
SAGE Publications, Ltd, 2008.
39.
TeddlieCYuF.Mixed methods sampling: a typology with examples. J Mix Methods Res2007;
1: 77–100.
40.
Nuno-SolinisRBerraondo ZabaleguiISauto ArceRet al.
Development of a questionnaire to assess interprofessional collaboration between two different care levels. Int J Integr Care2013;
13: 1–12.
41.
D’AmourDet al.
A model and typology of collaboration between professionals in healthcare organisations. BMC Health Serv Res2008;
8: 2.
42.
CrozierMFriedbergE.L'acteur et le système. Les contraintes de l'action collective.
Paris:
Seuil, 1977.
43.
FriedbergE.Le pouvoir et la règle: dynamiques de l'action organisée.
Paris:
Seuil, 1993.
44.
D'AmourDSicotteCLevyR.Collective action within interprofessional teams in health services. Sci Soc Sante1999;
17: 67–94.
45.
LipscombM.Abductive reasoning and qualitative research. Nurs Philos2012;
13: 244–256.
46.
ClaudiaUAdriana TironT.Qualitative studies in accounting: the abductive research strategy. SEA: Pract Appl Sci2014; 5
: 85–92.
47.
den Herder-van der EerdenMvan WijngaardenJPayneSet al.
Integrated palliative care is about professional networking rather than standardisation of care: a qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries. Palliat Med2018;
32: 1091–1102.
48.
AlbersGFroggattKVan den BlockLet al.
A qualitative exploration of the collaborative working between palliative care and geriatric medicine: barriers and facilitators from a European perspective. BMC Palliat Care2016;
15: 1–10.
49.
KainDAEisenhauerEA.Early integration of palliative care into standard oncology care: evidence and overcoming barriers to implementation. Curr Oncol2016;
23: 374–377.
50.
AldridgeMDHasselaarJGarraldaEet al.
Education, implementation, and policy barriers to greater integration of palliative care: a literature review. Palliat Med2016;
30: 224–239.
51.
CentenoCGarraldaECarrascoJMet al.
The palliative care challenge: analysis of barriers and opportunities to integrate palliative care in Europe in the view of national associations. J Palliat Med2017;
20: 1195–1204.
52.
BurnodALencludGRicard-HibonAet al.
Collaboration between prehospital emergency medical teams and palliative care networks allows a better respect of a patient's will. Eur J Emerg Med2012;
19: 46–47.
53.
MengerLMStallonesLCrossJEet al.
Strengthening suicide prevention networks: interorganizational collaboration and tie strength. Psychosoc Interv2015;
24: 155–165.
54.
CalderonCBalagueLIruinAet al.
Primary care and mental health care collaboration in patients with depression: evaluation of a pilot experience. Aten Primaria2016;
48: 356–365.
55.
MyorsKAClearyMJohnsonMet al.
A mixed methods study of collaboration between perinatal and infant mental health clinicians and other service providers: do they sit in silos?BMC Health Serv Res2015;
15: 13.
56.
WihlmanULundborgCSAxelssonRet al.
Barriers of inter-organisational integration in vocational rehabilitation. Int J Integr Care2008;
8: e52.
57.
BainbridgeDBrazilKKruegerPet al.
Evaluating program integration and the rise in collaboration: case study of a palliative care network. J Palliat Care2011;
27: 270–278.
58.
ReitingerEFroggattKBrazilKet al.
Palliative care in long-term care settings for older people: findings from an EAPC taskforce. Eur J Palliat Care2013;
20: 251–253.
59.
KimSKParkM.Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis.Clin Interv Aging2017;
12: 381–397.
60.
MonfortEBessePBelletAet al. Perceptions of quality of life and of patient-centered care by dependent people living in geriatric institutions and their relatives. Pratiques Psychologiques. 2018;
24: 389–402.
61.
KaramMBraultIVan DurmeTet al.
Comparing interprofessional and interorganizational collaboration inhealthcare: a systematic review of the qualitative research. Int J Nurs Stud2018;
79: 70–83.
