Timely integration of specialist palliative home care (SPHC) for patients with congestive heart failure, chronic obstructive pulmonary disease and dementia: qualitative evaluation of the experiences of SPHC physicians in the KOPAL trial

TY - JOUR

T1 - Timely integration of specialist palliative home care (SPHC) for patients with congestive heart failure, chronic obstructive pulmonary disease and dementia: qualitative evaluation of the experiences of SPHC physicians in the KOPAL trial

AU - Schade, Franziska

AU - Hüttenrauch, Danica

AU - Schwabe, Sven

AU - Mueller, Christiane A

AU - Pohontsch, Nadine Janis

AU - Stiel, Stephanie

AU - Scherer, Martin

AU - Marx, Gabriella

AU - Nauck, Friedemann

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/7/27

Y1 - 2024/7/27

N2 - OBJECTIVE: Chronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens. An intervention of an SPHC nurse-patient consultation followed by an interprofessional telephone case conference with the general practitioner (GP) was tested in the KOPAL trial ('Concept for strengthening interprofessional collaboration for patients with palliative care needs'). As part of the trial, the aim of this study was to gain in-depth insights into SPHC physicians' perspective on care with and without the KOPAL intervention for patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia (D).DESIGN: Qualitative evaluation of the KOPAL intervention from the perspective of SPHC physicians as part of the KOPAL trial. Thematic-focused narrative interviews analysed with grounded theory.SETTING: We conducted the KOPAL study and its qualitative evaluation in Lower Saxony and the greater Hamburg area, Germany.PARTICIPANTS: 11 physicians from 14 SPHC teams who participated in the trial were interviewed.RESULTS: A grounded theory of the necessity of collaboration between GPs and SPHC teams for patients with CHF, COPD and dementia was developed. From the perspective of SPHC physicians, patients with CNMD are generally difficult to manage in GP care. The timing of SPHC initiation is patient-specific, underscoring the need for collaboration between SPHC physicians and GPs. However, the primary mandate for healthcare should remain with GPs. SPHC physicians actively seek collaboration with GPs (eg, through the KOPAL intervention), viewing themselves as advisors for GPs and aspiring to collaborate as equal partners.CONCLUSION: Effective communication and the negotiation of future interprofessional collaboration are essential for SPHC teams.TRIAL REGISTRATION NUMBER: DRKS00017795.

AB - OBJECTIVE: Chronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens. An intervention of an SPHC nurse-patient consultation followed by an interprofessional telephone case conference with the general practitioner (GP) was tested in the KOPAL trial ('Concept for strengthening interprofessional collaboration for patients with palliative care needs'). As part of the trial, the aim of this study was to gain in-depth insights into SPHC physicians' perspective on care with and without the KOPAL intervention for patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia (D).DESIGN: Qualitative evaluation of the KOPAL intervention from the perspective of SPHC physicians as part of the KOPAL trial. Thematic-focused narrative interviews analysed with grounded theory.SETTING: We conducted the KOPAL study and its qualitative evaluation in Lower Saxony and the greater Hamburg area, Germany.PARTICIPANTS: 11 physicians from 14 SPHC teams who participated in the trial were interviewed.RESULTS: A grounded theory of the necessity of collaboration between GPs and SPHC teams for patients with CHF, COPD and dementia was developed. From the perspective of SPHC physicians, patients with CNMD are generally difficult to manage in GP care. The timing of SPHC initiation is patient-specific, underscoring the need for collaboration between SPHC physicians and GPs. However, the primary mandate for healthcare should remain with GPs. SPHC physicians actively seek collaboration with GPs (eg, through the KOPAL intervention), viewing themselves as advisors for GPs and aspiring to collaborate as equal partners.CONCLUSION: Effective communication and the negotiation of future interprofessional collaboration are essential for SPHC teams.TRIAL REGISTRATION NUMBER: DRKS00017795.

KW - Humans

KW - Palliative Care/methods

KW - Pulmonary Disease, Chronic Obstructive/therapy

KW - Heart Failure/therapy

KW - Dementia/therapy

KW - Qualitative Research

KW - Male

KW - Female

KW - Home Care Services/organization & administration

KW - Germany

KW - Middle Aged

KW - General Practitioners

KW - Attitude of Health Personnel

U2 - 10.1136/bmjopen-2024-085564

DO - 10.1136/bmjopen-2024-085564

M3 - SCORING: Journal article

C2 - 39067881

VL - 14

SP - e085564

JO - BMJ OPEN

JF - BMJ OPEN

SN - 2044-6055

IS - 7

ER -