A joint hospital initiative to strengthen general palliative care in the hospital: an action research study on challenges and facilitators.

backgroundProviding general palliative care in hospital settings challenges hospitals' multifaceted role in both saving lives and managing end-of-life care. The challenges in delivering general palliative care are compounded by organizational and cultural factors, underscoring the importance of establishing coordinated care frameworks for patients in their final stages of life. However, little is known about how to organize the enhancement of general palliative care in the hospital setting. The aim of this study is to examine the barriers and facilitators on the organizational level during the process of strengthening general palliative care within a joint hospital initiative.

methodsThis study is qualitative action research that follows four cyclical phases: 1. PROBLEM IDENTIFICATION: Qualitative interviews were performed with 24 departments and hospital management, totaling n = 64 participants. 2-3. Planning and taking action: Workshops were developed and performed in 14 departments. 4. EVALUATION: Qualitative evaluation interviews on the process were performed with 16 departments and hospital management, totaling n = 27.

resultsThe data analysis identified three central themes: 1: Delivering general palliative care - from lack of systematic approach to increased awareness; 2:. Strengthening interdisciplinary communication and collaboration and 3: Paraclinical involvement in palliative care - balancing treatment protocols with patient well-being. The results highlight barriers such as a lack of standardized structures and fragmented care approaches, alongside facilitators like employing dedicated palliative resource persons, increasing awareness of general palliative care, and involvement of paraclinical specialties who face ethical dilemmas balancing treatment protocols with patient well-being.

conclusionThis study highlights the complexity of the process of strengthening a joint initiative in a hospital setting, with identified barriers centered around interdisciplinary collaboration and paraclinical care integration. Enhancing collaboration faces challenges in knowledge dissemination and decision-making discrepancies. Overcoming these barriers is crucial to enhancing general palliative care delivery, emphasizing sustained initiatives in promoting collaboration, improving communication, and integrating healthcare sectors involved in palliative care. Continued education, training, and knowledge-sharing initiatives are essential for the ongoing general palliative care services and alignment with evolving patient needs and healthcare practices.