Palliative care consultation services - bridging gaps with general healthcare teams

Abstract

Palliative care consultation services support palliative care practice within healthcare settings outside of specialised palliative care. The overall aim of this thesis was to further our understanding of how palliative care knowledge can be translated into general healthcare settings and the factors influencing the integration of palliative care through palliative care consultation services. Study I mapped the published scientific literature from 2010 to 2019 on strategies for knowledge translation of a palliative approach. Various strategies were applied, and most studies were from high-income countries and focused on the hospital setting and patients with cancer. Study II examined the practice of palliative care consultation services in hospitals. Focus groups were held with consultation services, healthcare professionals from receiving wards, and managers. Variations in consultation practice were found, and some consultants proactively approached receiving wards. They were perceived to contribute with palliative knowledge, enhance cooperation and create space for palliative care. Their proactive practices meant that they provided "no ordinary consultation". Study III investigated factors associated with a palliative care consultation for patients dying outside specialised palliative care settings in their last week of life. Among the 265 129 included patients, 8.2% received a palliative care consultation. A palliative care consultation was more likely for patients who died from cancer (OR 8.55, 95% CI 8.15-8.98) and patients with a higher number of symptoms (OR 1.35, 95% CI 1.32-1.37). Other associated factors were age, place of death, education, healthcare region, living in a single household, and year of death. Study IV examined a clinical quality improvement project for early integrated palliative care within surgical care for patients with pancreatic cancer. The quality improvement practice included palliative care consultations for newly diagnosed patients with advanced cancer. Seventeen healthcare professionals shared their experiences of the project in interviews and observations. The main finding was that differences in perspectives on palliative care, integration and roles created prerequisites for palliative care integration through palliative care consultations. This thesis contributes to our understanding of knowledge translation strategies for palliative care, and of practices, processes, access, and influencing factors of palliative care consultation services.