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[Evaluation of Specialised Paediatric Palliative Home Care in Lower Saxony, Germany - A Qualitative Study on Parents'
K Kremeike1, A Mohr1, J Nachtmann2
1Pädiatrische Hämatologie und Onkologie, Medizinische Hochschule Hannover, Hannover.
Insights
Specialised paediatric palliative home care in Lower Saxony is positively rated by families. Improvements are needed in physician communication and psychosocial support for better outcomes.
Area of Science:
- Palliative Care
- Pediatric Healthcare
- Home Health Services
Background:
- Germany established a legal right to specialized pediatric palliative home care in 2007.
- Lower Saxony implemented a comprehensive specialized pediatric home care (SPPHC) program coordinated by a central office since 2010.
- Regional teams of nursing, medical, and psychosocial specialists provide care for children with life-limiting conditions.
Purpose of the Study:
- To evaluate the effectiveness and parent satisfaction with the specialized pediatric home care (SPPHC) program in Lower Saxony.
- To identify areas for improvement in pediatric palliative home care services.
Main Methods:
- Semi-structured interviews were conducted with 20 parents of children aged 3-18 eligible for SPPHC.
- 13 families had experience with SPPHC, while 7 did not.
- Data were analyzed using content analysis, with parent satisfaction evaluated using a predefined scheme.
Main Results:
- Six key dimensions of pediatric palliative home care were identified: benefit, continuity, team perception, end-of-life care, communication, and parent information.
- Parents with SPPHC experience rated the benefit, continuity, and team perception more favorably than those without.
- Areas for improvement include increased physician presence, enhanced communication, better psychosocial support, and optimized follow-up care.
Conclusions:
- The implementation of specialized pediatric palliative home care (SPPHC) in Lower Saxony received positive ratings from families.
- The study identified specific areas for service enhancement to further improve care quality.
Background:
In 2007 the children's right to specialised paediatric palliative home care became law in Germany. This claim should be met in Lower Saxony by the establishment of a comprehensive specialised paediatric home care (SPPHC). Since April 2010, a central office undertakes the coordination and administration throughout the federal state. Regional teams comprising nursing, medical and psychosocial specialists care for the children and adolescents suffering from complex conditions due to life-limiting conditions - subsidiary to regional health care providers. The aim of the study was to evaluate SPPHC in Lower Saxony.
Methodology:
From June 2012 to February 2013, semi-structured interviews were conducted with 20 parents of children aged from 3 to 18 years. The young patients fulfilled all criteria to be eligible for SPPHC. 13 of the families experienced SPPHC. 7 families did not utilise the specialised care, mostly because the palliative situation occurred before the implementation of specialised care. Data were analysed using content analysis (Mayring). Therefore, key aspects of paediatric palliative home care were summarised in main categories. The evaluation of parent's satisfaction with palliative home care was performed by an evaluation scheme developed for the main categories (very good - good - bad- very bad) and operated for every case.
Results:
6 dimensions of paediatric palliative home care were identified: (i) benefit of care, (ii) continuity of care, (iii) perception of care providers as a team, (iv) dealing with the issues death and dying/hospice and palliative, (v) care provider's communication/cooperation with parents, and (vi) parent's Information. As all parents clearly indicated a rating on the first 3 categories, these categories were selected for the evaluation of parent's satisfaction with the received home care. The evaluation revealed that parents experienced in SPPHC looked upon these 3 main categories more favourably than parents without the experience of SPPHC. As room for improvement, the respondents requested the extension of physician's presence and communication with the families as well as with each other, efforts to better meet the needs of psycho-social support of the families and to optimise follow up-care.
Conclusion:
The implementation of SAPPV was rated positively by the concerned families. In addition, options for improvement could be identified.
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