Ethnography into a clash of cultures between generalists and specialists in palliative care: interview with Melinda Smith

Categories: Research.

Your research focusses on hospital team cultures that affect access referral to specialist palliative care. Why is there a need for this research?

The level of palliative care need globally is great, but not all who need it receive it. This is only set to worsen in the future given the ageing population and the associated increase in chronic conditions and complex co-morbidities. Our research aimed to understand more about what might hinder or help access to specialist palliative care (SPC) services in the acute hospital setting. Helping to maximise the benefits of palliative care, for example through early referrals to SPC services, may help with advanced care planning and allow health professionals to better meet complex needs going forward.

From 10 interviews with health care professionals (five SPC staff and five non-SPC staff), four distinctive cultures of the referring team emerged which may serve to hinder or help access to SPC services. The identification of these hospital team cultures offers insight into how we may promote timely access to palliative care.

Why did you choose ethnography as a method?

Ethnography helps to position our findings within context of hospital palliative care. We observed what happened in the hospital (through staff shadowing, ward rounds, multi-disciplinary meetings) in addition to conducting interviews with staff to help understand more about the hospital culture and systems-type information. Much of our ethnographic data confirmed our interview findings on hospital team cultures.

What conclusions did you come to?

As stated, one of our major findings was the identification of four team cultures of the referring team that may influence if and when a patient receives SPC. The ‘self-sufficient’ team feel comfortable with providing palliative care themselves and hardly refer to SPC, while the ‘over-reliant on SPC’ team excessively refer patients to SPC, including those with less complex needs. One team culture, ‘curative’, tend to refer to SPC in the late stages of illness, once curative treatment has failed, whereas the ‘collaborative with SPC’ team access SPC appropriately alongside curative treatment, when patients have complex needs. 

Our findings recognise that access to SPC currently isn’t always based on patient need, and hospital team culture may play a part. In order to improve SPC access and meet the growing demand for palliative care we need to support and educate referring teams. Specifically, we need to concentrate on defining the scope of SPC and highlight when it is appropriate to refer; build an open culture around death and dying; and equip and empower staff with the skills to assess and respond to palliative care needs throughout the illness trajectory. Finally, we need to help promote the features of the ‘collaborative with SPC’ team culture to encourage joined up working between the referring team and SPC early on.

You have a very impressive list of co-authors! How do you feel to be chosen to present this research on behalf of your team?

Very honoured! This is a large international study with a large number of top researchers in palliative care, so it is a great privilege for me to be presenting some of our early findings. On a personal level it is also very rewarding to be able to present data that I have collected in the field, and to see the research come full circle.

In your opinion, in what way does the EAPC Congress advance research in palliative care?

What I really like about the EAPC Congress is the real mix of disciplines of palliative care that are showcased, from research to implementation and engagement to challenges and solutions. Bringing both researchers and clinicians together is really exciting, with research helping to inform practice and real-world clinical problems inspiring new ideas for research.

What are you most looking forward to about the Congress in Copenhagen?

On the scientific level I am really looking forward to being inspired and educated by all the many interesting presentations from all over the world. This is my very first palliative care conference and I am delighted to be attending. On the ‘touristy’ level, I am looking forward to taking a couple of days out after the conference to do some sightseeing in Copenhagen. Scandinavia is beautiful and I can’t wait to see a bit more of it!

Is there anything I haven’t asked about that you would like to add?

The theme for this year’s EAPC Congress is ‘building bridges’ which I think nicely ties in with the central theme of my presentation. Our findings show that there is a real need for health professionals to work in a better way together to support each other and respond to deterioration early, helping patients and families receive the type of care they wish.

Catch Melinda’s presentation during ‘Free Communictaion’ session FC09 on Saturday 9 May at the EAPC World Congress

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