Specialized palliative home care teams : complementary perspectives of team functions and influences on patients and families

摘要

Persons with life-threatening illness are increasingly being cared for and dying athome. Palliative care strives to cater to multiple dimensions such as physical,psychosocial and spiritual or existential, and meeting these needs in patients andfamilies requires multiple competencies. Palliative care organizations proposeorganization and delivery of care in teamwork models; however, teamwork is complexand can be approached from various perspectives. Previous research has identifiedgaps in palliative care regarding which components of teamwork are most effective.The overall aim of this thesis was to explore perspectives of team function inspecialized palliative care teams, among health care professionals, families andpatients. Study I entailed translation and cultural adaptation of a researchquestionnaire. Study II entailed qualitative interviews with health care professionals(n=15) working in specialized palliative home care and Study III interviews withpatients (n=6) and family members (n=7). In Study IV, an exploratory design wasused. Initially team leaders (n=77) in palliative care reported team function. Next,health care professionals (n=61) reported team development in the group developmentquestionnaire, patients (n=43) reported symptoms in the Edmonton SymptomAssessment System and family members (n=45) reported satisfaction with care in thetranslated and culturally adapted FAMCARE-2 questionnaire. Results of the studiesare: (I) a translated culturally adapted and initially tested Swedish language version ofthe FAMCARE-2 scale, (II) health care professionals report that competence,communication and organization are crucial components of teamwork in specializedpalliative homecare, (III) patients and families report that they experience security andcontinuity of care due to 24/7 care, sensitivity to changing needs and demonstratingcaring, and (IV) specialized palliative home care teams have a core of registerednurses, physicians and social workers. Positive associations were found between teammaturity and team effectiveness.