title: Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study.
abstract: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse.
  
  
  
  To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care.
  
  
  
  A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments.
  
  
  
  A Danish regional hospital with 29 department managements and one hospital management.
  
  
  
  Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation.
  
  
  
  Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.
authors.affiliation: The Regional Research Unit, Region Zealand, Denmark Department of Surgery, Roskilde-Koege Hospital, Koege, Denmark hbz@regionsjaelland.dk.
authors.forename: Heidi
authors.initials: H
authors.lastname: Bergenholtz
authors.affiliation: PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Jarlbaek
authors.affiliation: Roskilde-Koege Hospital, Denmark The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Bibi
authors.initials: B
authors.lastname: Hølge-Hazelton
mesh_terms: D001291:Attitude of Health Personnel; D054521:Cultural Competency / Q000523:psychology*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003718:Denmark; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007400:Interprofessional Relations; D009937:Organizational Objectives; D010166:Palliative Care / Q000458:organization & administration*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*
keywords: Palliative care; culture; hospitals; integrated care; organisation and administration