title: Shared care: the barriers encountered by community-based palliative care teams in Ontario, Canada.
abstract: To meet the complex needs of patients requiring palliative care and to deliver holistic end-of-life care to patients and their families, an interprofessional team approach is recommended. Expert palliative care teams work to improve the quality of life of patients and families through pain and symptom management, and psychosocial spiritual and bereavement support. By establishing shared care models in the community setting, teams support primary healthcare providers such as family physicians and community nurses who often have little exposure to palliative care in their training. As a result, palliative care teams strive to improve not only the end-of-life experience of patients and families, but also the palliative care capacity of primary healthcare providers. The aim of this qualitative study was to explore the views and experiences of community-based palliative care team members and key-informants about the barriers involved using a shared care model to provide care in the community. A thematic analysis approach was used to analyse interviews with five community-based palliative care teams and six key-informants, which took place between December 2010 and March 2011. Using the 3-I framework, this study explores the impacts of Institution-related barriers (i.e. the healthcare system), Interest-related barriers (i.e. motivations of stakeholders) and Idea-related barriers (i.e. values of stakeholders and information/research), on community-based palliative care teams in Ontario, Canada. On the basis of the perspective of team members and key-informants, it is suggested that palliative care teams experience sociopolitical barriers in an effort to establish shared care in the community setting. It is important to examine the barriers encountered by palliative care teams to address how to better develop and sustain them in the community.
authors.affiliation: School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada. demigllf@mcmaster.ca
authors.forename: Lily
authors.initials: L
authors.lastname: DeMiglio
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D003153:Community Health Services / Q000458:organization & administration; D019058:Community Networks; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team; D011320:Primary Health Care; D036301:Qualitative Research; D013727:Terminal Care / Q000458:organization & administration*