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Table 2 Results of identified categories and subcategories with physicians’ indications concerning the addressed aspects

From: Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

Categories and SubcategoriesIndications
(n = 19)
Details/Explanation
PC specialist
(n = 10)
Requesting physician
(n = 9)
“Issues leading to an IPCC request”
 Physical symptom burden++++++Included different physical symptoms in pts
 Patients’ quality of life+When the treating team assumed that quality of life could be improved by IPCC
 Psychological distress+++++Included pts’ and family caregivers distress
  • Patients+++
  • Family caregivers++
 Overstraining+++++When family caregivers and the treating team were overwhelmed with dealing with pts
  • Family caregivers++
  • Treating team (health care professionals)+++/++a
 Organisation of further care++++++Support needed in organisation of Out of hospital care or transfer to PCU
 Social-legal matters+Aspects that needed counselling on social-legal matters, e.g. advance directive
 Decision-making+Support needed talking to pts. about decisions / the pts’ situation / medical reasonability
 Change of therapeutic goal++Support needed in talking to pts. about therapeutic goals / to discuss medical reasonability
 Limited staff resources(+)++Pts in need of specialized PC are often time consuming and treating teams cannot meet the needs and therefore ask for support
“Barriers on regular wards concerning treatment of patients with PC needs”
 Connection of further outpatient palliative care+++Treating teams are not in contact with outpatient palliative care services and lack knowledge on how to organize it
 Coping(+)(+)Regular wards have limited access to psychosocial support to assist pts. to deal with their situation
 Lack of privacy (single rooms)++++Regular wards usually have limited single rooms and little options for private conversations
 Resources of the requesting team  Requesting physicians can be overwhelmed by the complexity of symptoms and psycho-social needs of pts., and not competent to treat these, also regular wards lack the preferable extent of multidisciplinarity
  • Overstraining+++
  • No multidisciplinarity++(+)
  • Lack of knowledge++++
  • Lack of time+++++
“Impact of IPCC”
 Transfer of knowledge to the requesting team+(+)Through IPCC non-PC teams are educated in PC
 Relief for the requesting team++++Time consuming care and advice concerning palliative situations can be yield to the IPCC-team
 Relief for family care givers+(+)IPCC teams include family care givers in their treatment approach which helps them to get about the situation
 Better patient coping+++IPCC supports pts. in coping with the disease/palliative situation
 Improvement of symptom burden++++Included different physical symptoms in pts
 Improvement of further care (outside of the hospital)++(+)IPCC improves out of hospital care like organisation of hospice care or other connection to further PC support
“Limitations for the IPCC-Team”
 Limited insight and treatment options in complex cases++++IPCC offers only limited time to get to know pts. and their habits. IPCC is also limited in time to grasp the course of (often long-lasting) disease
 Limited resources++++++Due to limited (IPCC-) staff they are limited in their offers
“Barriers concerning request, conduct and implementation of IPCC”
 Request
  Refusal of patients and family care givers++++Pts/Family care givers refuse IPCC before having spoken to a IPCC-member
  Fear of denigration+When requesting physicians fear of not having things done correctly and be showed up in front of colleagues
  Overconfidence / Resistance+++(+)When non-PC-physicians believe they know what’s best for the patient and don’t accept any other approaches and therefore do not request IPCC support
  Lack of knowledge of the requesting team++++Without adequate knowledge the requesting team cannot identify situations or patients that/who would profit from PC.
  Limited time+Limited time to fill out the request form or even to think about treating options in terms of PC
  Assumption of missing benefit for the patient+The treating team feels that there is no benefit for pts. from additional PC treatment
  No problems at all+++Meaning that no aspect prevents actions completely
 Conduct
  No provision of an adequate settingRegular wards have littler privacy, mostly no single rooms or meeting rooms with the option of speaking in private
  Lack of preparation by the requesting team++When the IPCC team arrives, the treating team neglected to tell pts. about including IPCC or they have scheduled a treatment and pts. is therefore not available for consultation
  Limited time+++Limited time of the treating team so they are not open to discuss the situation and treatment options with the IPCC team
  Limited time of the IPCC-Team+++To complete all requests during a day there is limited time for pts
  Patients refusal(+)Pts reject a consultation when actually meeting with the IPCC team
  No problems at all+++Meaning that no aspect prevents actions completely
 Implementation of IPCC-suggestions
  Patients’ or family care givers’ refusal(+)(+)After IPCC pts./family care givers reject the proposed approach
  Insecurity, lack of knowledge+++(+)The treating team feels uncomfortable with the proposed approach and therefore do not implement it, due to insecurity and a lack of knowledge
  Resistance, Ignorance+++The treating team does not believe in the proposed approach and that it would not be more helpful than their own treatment
  Limited time++Due to the treating teams limited time they do not read IPCC suggestions properly and/or do not adjust the medication or treatment plan
  No problems at all(+)++Meaning that no aspect prevents actions completely
  1. Number of interviews aspects were mentioned: - = none, (+) = one time, + = up to 1/3, ++ = up to 2/3, +++ = up to 3/3; aThreshold region
  2. PC Palliative care, IPCC Inpatient palliative care consultation, pts Patients, PCU Palliative care unit
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