Organizational Interventions concerning Palliation in Community Palliative Care Services: A Literature Study

Table 2

Development initiatives concerning the cooperation between medical practices and other organisational units.

Author, year, and place	The aim	Development initiatives/interventions	Methods of evaluation	Conclusion
King et al., 2003 [21], UK	To examine the experiences of primary care practitioners in using the out-of-hours protocol, and their perceptions of its effectiveness.	The protocol was organised around four priority areas: communication; care support; specialist medical advice; drugs and equipment.	Four group interviews with 20 district nurses and individual telephone interviews with 15 GPs.	The protocol had facilitated better communication between in- and out-of-hours services; promoted a more anticipatory approach to care; better access to drugs through the Bearder bags.; Recommendations for future development: carer support, regularly updating the forms of the scheme.
Brumley et al., 2006 [20], Australia	To improve access to clinical information for nurses and doctors providing after hours community palliative care in a regional Australian setting.	Development of a single information sheet on the community palliative care service computers with: medical history; treatments, current status; up-to-date medications list; progress notes; risks and problems; symptom control; contact information; doctors’ letters; expectations of care.	Palliative care nurses and GPs surveys and focus group feedback; the number of accurate predictions of unstable palliative care patients that resulted in call-outs after hours; patient satisfaction survey following after hours service.	Information would have been useful if GPs had been contacted about patients after hours.; The palliative care nurses felt confident with the assessments being more professional in their practice with other medical colleagues, were able to provide current information.
Munday et al., 2007 [23], UK	To explore the effectiveness and sustainability of the implementation of The Gold Standards Framework (GSF) at practice level.	Implementation of GSF at practice level in 15 practices from three areas in the UK which had commenced GSF implementation between March 2003 and September 2004.	Interviews and observational data with 15 practices participating in GSF. Semi-structured interviews (total 45) with GPs, community nurses, and practice managers. Supplied by observation of practice meetings and systems, to provide contextual insights. Analysis: thematic matrix approach and comparison between practices.	High performing practice of GSF procedures implied clear, shared purpose for palliative care with effective communication. Few performing practices demonstrated little utilization of basic GSF processes and deficiencies in interprofessional communication.
Mahmood-Yousuf et al., 2008 [22], UK	To investigate the extent to which the framework (Gold Standards Framework (GSF)) influences interprofessional relationships and communication, and to compare GPs’ and nurses’ experiences.	Implementation of GSF at practice level in 15 practices from three areas in the UK, which had commenced GSF implementation between March 2003 and September 2004.	15 practices participated. 38 semi-structured interviews with GPs, district nurses, Macmillan nurses, and framework facilitators.	Adoption of GSF resulted in earlier referral of palliative care patients to district nurses.; Multidisciplinary team meetings enabled communication for sharing knowledge, discussing management problems, but arranging and maintaining meetings were often problematic. Nurses in particular valued formal meetings while GPs generally preferred informal and ad hoc dialogues. The best functioning teams used a mixture of formal and informal meetings with a relatively nonhierarchical working style.
Walshe et al., 2008 [24], UK	To present data on the anticipation and adoption of the GSF.	Implementation of the GSF within three Primary Care Trusts in North West England.	47 interviews with generalist and specialist palliative and primary care professionals (district nurses, GP, allied health professionals, managers commissioners, specialist palliative care nurses, doctors, and allied health professionals).	Positive benefits to professionals included improved interprofessional communication and anticipatory prescribing. Negative aspects were increased nursing workload and the possibility of fewer or later visits to patients. GSF needed local champions to be sustainable. Slow or incomplete adoption was reported.