title: Introducing a model incorporating early integration of specialist palliative care: A qualitative research study of staff's perspectives.
abstract: BACKGROUND
  Palliative care has evolved to encompass early integration, with evaluation of patient and organisational outcomes. However, little is known of staff's experiences and adaptations when change occurs within palliative care services.
  
  
  OBJECTIVE
  To explore staff experiences of a transition from a service predominantly focused on end-of-life care to a specialist service encompassing early integration.
  
  
  METHODS
  Qualitative research incorporating interviews, focus groups and anonymous semi-structured questionnaires. Data were analysed using a comparative approach. Service activity data were also aggregated.
  
  
  METHODS
  A total of 32 medical, nursing, allied health and administrative staff serving a 22-bed palliative care unit and community palliative service, within a large health service.
  
  
  RESULTS
  Patients cared for within the new model were significantly more likely to be discharged home (7.9% increase, p = 0.003) and less likely to die in the inpatient unit (10.4% decrease, p < 0.001). While early symptom management was considered valuable, nurses particularly found additional skill expectations challenging, and perceived patients' acute care needs as detracting from emotional and end-of-life care demands. Staff views varied on whether they regarded the new model's faster-paced work-life as consistent with fundamental palliative care principles. Less certainty about care goals, needing to prioritise care tasks, reduced shared support rituals and other losses could intensify stress, leading staff to develop personalised coping strategies.
  
  
  CONCLUSIONS
  Services introducing and researching innovative models of palliative care need to ensure adequate preparation, maintenance of holistic care principles in faster work-paced contexts and assist staff dealing with demands associated with caring for patients at different stages of illness trajectories.
authors.affiliation: Palliative Care Service, Cabrini Health Australia, Prahran, VIC, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia nmichael@cabrini.com.au.
authors.forename: Natasha
authors.initials: N
authors.lastname: Michael
authors.affiliation: Palliative Care Service, Cabrini Health Australia, Prahran, VIC, Australia Department of Medicine, St Vincent's University Hospital, The University of Melbourne, Parkville, Vic, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: O'Callaghan
authors.affiliation: Cabrini Monash Psycho-oncology, Cabrini Health Australia, Prahran, VIC, Australia Department of Psychiatry, Monash University, Melbourne, VIC, Australia.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Brooker
authors.affiliation: Palliative Care Service, Cabrini Health Australia, Prahran, VIC, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Walker
authors.affiliation: Mercy Hospital for Women, Melbourne, VIC, Australia Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville VIC, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Hiscock
authors.affiliation: David Phillips, Business Intelligence Unit, Cabrini Health Australia, Prahran, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010166:Palliative Care / Q000458:organization & administration*; D036301:Qualitative Research; D013038:Specialization; D013727:Terminal Care / Q000458:organization & administration
keywords: Early integration palliative care; hospices; palliative care; qualitative research