Healthcare professionals' perceived barriers in providing palliative care in primary care and nursing homes: a survey study

Katrin Kochems; Everlien de Graaf; Ginette M Hesselmann; Marieke J E Ausems; Saskia C C M Teunissen

doi:10.1177/26323524231216994

Healthcare professionals' perceived barriers in providing palliative care in primary care and nursing homes: a survey study

Palliat Care Soc Pract. 2023 Dec 25:17:26323524231216994. doi: 10.1177/26323524231216994. eCollection 2023.

Authors

Katrin Kochems¹, Everlien de Graaf², Ginette M Hesselmann³, Marieke J E Ausems⁴, Saskia C C M Teunissen²

Affiliations

¹ Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht 3508 GA, The Netherlands.
² Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
³ Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Academic Hospice Demeter, De Bilt, The Netherlands.

Abstract

Background: Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients' and relatives' values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored.

Objectives: To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals.

Design: Cross-sectional survey study.

Methods: A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics.

Results: In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers.

Conclusion: In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting.

Keywords: multidimensional care; multiprofessional care; nursing home; palliative care; primary care; survey.