CN33 - Health care professionals’ perceptions regarding shared clinical decision-making in both acute and palliative cancer care, a qualitative study and its clinical implications

Background

Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care may be challenging, and there is no golden standard model for integration. Fragmented care is associated with sub-optimal communication, collaboration, and ineffective care. This may lead to unnecessary care transitions, and impact patient safety. We performed a study with the aim to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home.

Methods

Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis.

Results

Six online focus-group interviews were performed. Few signs of systematic integration between acute and palliative care teams were found, risking fragmented care and putting the patients in vulnerable situations. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors and uncertainty related to responsibilities impacted clinical decisions. We found barriers to timely end-of-life conversations and clinical decisions on optimal care. In addition, the appropriateness of transfer to acute care, seemed to be related to lack of knowing which team was responsible.

Conclusions

Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources). Clinical implications: We started two main integration projects based on this study, one piloting direct admission to specialized palliative inpatient ward directly from the emergency room. The other on-going project will try digital visits with patient, the oncology, and the palliative team, aiming to discuss goals-of-care. The results and what we learned from those integration projects will be presented.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Regional Cancer center, Stockholm-Gotland, Sweden.

Disclosure

All authors have declared no conflicts of interest.