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BMC Palliative Care
Published in: BMC Palliative Care 1/2018

Open Access 01-12-2018 | Research article

What does ‘complex’ mean in palliative care? Triangulating qualitative findings from 3 settings

Authors: Emma Carduff, Sarah Johnston, Catherine Winstanley, Jamie Morrish, Scott A. Murray, Juliet Spiller, Anne Finucane

Published in: BMC Palliative Care | Issue 1/2018

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Abstract

Background

Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care.

Methods

Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings.

Results

The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care.

Conclusions

Complexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life.
Appendix
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Metadata
Title
What does ‘complex’ mean in palliative care? Triangulating qualitative findings from 3 settings
Authors
Emma Carduff
Sarah Johnston
Catherine Winstanley
Jamie Morrish
Scott A. Murray
Juliet Spiller
Anne Finucane
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2018
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-017-0259-z

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