Generalist palliative care in hospital: Cultural and organisational interactions. Results of a mixed-methods study.

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Heidi Bergenholtz, Lene Jarlbæk, Bibi Hølge-Hazelton

Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse.
Aim: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care.
Design: A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in whichthree independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative,ethnographic study exploring the culture of generalist palliative nursing care in medical departments.
Setting/participants: A Danish regional hospital with 29 department managements and one hospital management.
Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use of generalist palliative care clinical guideline’,suggesting that the guideline had not reached all levels of the organisation.
Conclusion: Contrasting issues in the hospital’s provision of generalist palliative care at different organisational levels seem tohamper the interactions between organisation and culture – interactions that appear to be necessary for the provision of integratedpalliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on diseaseoriented treatment, which is reflected at all the organisational levels.
Original languageEnglish
JournalPalliative Medicine
Volume30
Issue number6
Pages (from-to)558–566
Number of pages9
ISSN0269-2163
DOIs
Publication statusPublished - Jun 2016

ID: 157317928