What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings

Carduff, E., Johnston, S., Winstanley, C., Morrish, J., Murray, S. A., Spiller, J. and Finucane, A. (2018) What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings. BMC Palliative Care, 17, 12. (doi: 10.1186/s12904-017-0259-z) (PMID:29301524) (PMCID:PMC5753489)

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Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Item Type:Articles
Additional Information:Emma Carduff, Anne Finucane and Juliet Spiller’s hospice posts are supported by Marie Curie.
Keywords:Complex need, hospices, hospital, palliative care, primary health care.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Carduff, Dr Emma
Authors: Carduff, E., Johnston, S., Winstanley, C., Morrish, J., Murray, S. A., Spiller, J., and Finucane, A.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:BMC Palliative Care
Publisher:BioMed Central
ISSN:1472-684X
ISSN (Online):1472-684X
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in BMC Palliative Care 17: 12
Publisher Policy:Reproduced under a Creative Commons License

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