Physicians’ perceived barriers and proposed solutions for high-quality palliative care in dementia in the Netherlands: Qualitative analysis of survey data

Author:

Bavelaar L.,van der Steen H.T.A.,de Jong H.,Carter G.,Brazil K.,Achterberg W.P.,van der Steen J.T.

Abstract

Background: The literature indicates that palliative care for people with dementia needs to be enhanced. Objectives: To assess barriers to providing high-quality palliative dementia care and potential solutions to overcome these barriers, as perceived by physicians responsible for end-of-life care with dementia. Design: Cross-sectional study. Setting: The Netherlands. Participants: A representative sample of 311 elderly care physicians of whom 67% (n=207) responded. Measurements: A postal survey in 2013 containing open-ended items probing for barriers in the elderly care physicians’ practices and possible solutions. Answers were coded and grouped using qualitative content analysis and presented to expert physicians in 2021. Results: Barriers to palliative care in dementia were (1) beliefs held by family, healthcare professionals or the public that are not in line with a palliative care approach, (2) obstacles in recognizing and addressing care needs, (3) poor interdisciplinary team approach and consensus, (4) limited use or availability of resources, and (5) poor family support and involvement. Suggested solutions were improving communication and information transfer, and educating healthcare staff, families and the public about palliative care in dementia. Timely and frequent communication with the family, including advance care planning, and more highly skilled nursing staff were also proposed as solutions. Conclusions: The results suggest a strong need for ongoing education for healthcare professionals about palliative dementia care. Strengthening interprofessional collaboration and shared responsibility for advance care planning is also key. Increasing public awareness of the dementia trajectory and the need for a proactive approach call for a broader societal agenda setting.

Publisher

SERDI

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1. Situational Analysis of Barriers to Continuity of End-of-Life Care in Urban Areas, Bangkok;Journal of Social Work in End-of-Life & Palliative Care;2023-11-17

2. Advance Care Planning in the Netherlands;Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen;2023-08

3. I want to be seen as myself: needs and perspectives of persons with dementia concerning collaboration and a possible future move to the nursing home in palliative dementia care;Aging & Mental Health;2023-06-24

4. A Situation-Specific Theory of End-of-Life Communication in Nursing Homes;International Journal of Environmental Research and Public Health;2023-01-03

5. Nurse-Physician Communication Around Identifying Palliative Care Needs in Nursing Home Residents;Journal of the American Medical Directors Association;2021-10

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