Early Integration of Palliative Care in Hospitals: How Can Palliative Care Consultation Teams Drive Practice Change?

Early integration of palliative care within disease-oriented care is advocated but the question of how this is best accomplished remains. In the context of surgical care for patients with pancreatic cancer, a quality improvement initiative was introduced whereby palliative care consultations were offered early in the disease trajectory. We devised a qualitative study using an interpretive description design, focusing on the integration of palliative care consultation practice and collaboration between actors. The aim of the study was to examine a practice-driven change for the early integration of palliative care within surgical cancer care. Seventeen study participants (healthcare professionals, managers and patient association representatives) were interviewed. The interviews were complemented by observations, and a constant comparative analysis was applied. This study found that the development and success of the quality improvement initiative were shaped by the interplay among three key actors - the palliative care team, the surgical team, and the patient and their family - and were further influenced by organisational factors, project structure and implementation, and broader societal circumstances. Within these domains, perspectives on what, when and how to integrate palliative care proved pivotal and need to be disclosed when initiating collaboration between palliative care consultation services and specialist hospital teams.