Dr Claudia Virdun1,2, Dr Gursharan Singh2, Distinguished Professor Patsy Yates2, Professor Jane Phillips2, Professor Alison Mudge3,4
1Research Centre for Palliative Care, Death, and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia, 2Faculty of Health, Cancer and Palliative Care Outcomes Centre, Queensland University of Technology (QUT), Brisbane, Australia, 3Department of Internal Medicine and Aged Care, Royal Brisbane and Women’s Hospital, Brisbane, Australia, 4Centre for Health Services Research, The University of Queensland, Brisbane, Australia
Biography:
Dr Claudia Virdun is a specialist palliative care nurse with extensive clinical experience and a strong commitment to improving care for people with advanced serious illness—across all settings. Her passion for excellence in palliative care drives her research and quality improvement work, which informs meaningful service change. In addition to her research, Claudia plays a key role in workforce development as part of the teaching team for Flinders University’s postgraduate palliative care program.
Abstract:
Background:
Hospitals play an important role in the care of people with palliative care needs. There is robust information about what patients and families need for high quality care within the hospital context, but enabling this in practice remains elusive.
Aim:
To understand perspectives of multidisciplinary clinicians providing acute inpatient care on the barriers and enablers at clinician, team and organisational levels to integrating good palliative care into the acute care setting.
Methods:
An exploratory-descriptive qualitative study using semi-structured interviews and practical thematic analysis to obtain an in-depth analysis of context from the clinician perspective. Undertaken in a large Australian tertiary referral hospital, multidisciplinary clinicians were recruited from three wards (cancer care, mixed general medicine/renal and mixed general medicine/respiratory) selected because they provide care for large numbers of patients with chronic life limiting illnesses.
Results:
Eighty-eight interviews were undertaken (nursing – 39, medicine – 24, allied heath – 25). Analysis generated six themes that describe the challenges and opportunities for providing optimal inpatient palliative care:
1.Understanding when and how to provide palliative care
2.Negotiating shared or changing medical governance in a siloed system
3.Supporting clinicians with the knowledge, skills and confidence to meet palliative care needs
4.Prioritising palliative care amidst the acute care demands of the hospital
5.Optimising the clinical environment to enable private, restful and family-friendly spaces
6.Harnessing organisational support and multidisciplinary clinical leadership
Conclusion:
Multidisciplinary clinicians working within the hospital setting continue to be unclear about how and when to provide palliative care. Navigating clinical uncertainty for people with advanced incurable disease remains complex within a system that prioritises acute episodic care and siloed medical governance. Optimising clinical environments to enable more person-centred care is needed. Executive support and adequate resourcing to empower clinical teams to provide integrated palliative care is required.