Delivering Palliative Care in an Acute Hospital Setting: Views of Referrers and Specialist Providers

There has been a steady expansion, of hospital-based palliative care in the United Kingdom, but limited published research on health professionals' view of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were lope recorded and transcribed verbatim. Data were analyzed, thematically using a framework, analysis approach. The study found large areas of agreement between referrers and providers oil what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility oil the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care zoos also identified; in particular, whether specialists should. be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation, Of specialist advice by referrers. Such perspectives on the interface of genera list and specialist provision provide insights into improving care for palliative patients in the acute hospital setting. J Pain Symptom Manage 2009;38:327-340. (C) 2009 U.S. Cancer Pain Relief Committee. Pablished by Elsevier Inc. All rights reserved.