Table 2 Results of identified categories and subcategories with physicians’ indications concerning the addressed aspects
Categories and Subcategories | Indications (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 setting | – | – | Regular 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 |