Table 1.
Essential Elements of Quality Palliative Care in the Home by Individual Sources and Overall Synthesis
| Synthesis essential elements | Review of common palliative homecare components (% of studies, in at least half of programs)28 | Existing effective palliative care teams33 | Bereaved caregiver perspectives35,36 | Perspectives of Canadians (general public) (themes with at least 91% agreement)37 | Perspectives of palliative care providers (% indicating theme)38 |
|---|---|---|---|---|---|
| (1) Teamwork within and across settings | Homecare linkage with hospital, primary care, and other community agencies (73%) | Open intrateam communication among providers including primary care | Good communication with patient/family and between providers | Someone in the system to coordinate care | See D below |
| Seamless transitions, good communication, primary care involvement | |||||
| (2) Management of pain and physical symptoms | Pain and symptom management (60%) | See B below | Adequate nursing hours and personal support is provided in the home | Daily assistance with caregiving as needed | Addressing the physical needs (47%) |
| Ensuring that the patient is as comfortable as possible | See A below | See C below | Access to equipment | ||
| (3) Holistic management of nonphysical and physical symptoms | Presence of a multidisciplinary team (67%) | B: Proactive, holistic physical symptom, and psychosocial-spiritual management | See C below | Addressing the nonphysical needs (55%) | |
| Management of nonphysical symptoms (60%) | Advocating for patient preferences in care and setting | Communication and relationship development (36%) | |||
| Includes emotional and spiritual support, life closure, finding peace, development of relationship, and a care team that works interprofessionally | A: Needs-driven customized care plan, including assessment (48%). | Supporting patients to resolve personal affairs and realize goals, toward achieving peace and fulfillment | |||
| (4) Having the right people on the team | Providers with palliative care expertise or training (63%) | Providers have a basic knowledge in palliative care | D: Healthcare teams' “nature” of palliative care delivery, that is, care is companionate and cohesive (52%) | ||
| Providers who are dedicated, skilled, and compassionate and a system to support these providers to practice in this manner | Consistency in providers that are caring and compassionate | Society and the health system have a culture of supporting palliative care (7%) | |||
| (5) Timely and responsive | On-call around the clock accessibility (50%) | Around-the-clock access to specialized palliative care expertise | C: Care is timely in response to the patient's physical and nonphysical needs | 24/7 access to a nurse | Patient wishes are honored (51%) |
| Access to a member of the care team when crisis occurs, also proactive symptom management, early identification, and being in the “right” setting. 24/7 access is ideal but not always feasible or necessary | Timeliness in responding to the needs of patients and families in an appropriately quick and timely manner | Panic alerts/buttons for patients when left alone | |||
| (6) Patient and family preparedness | Patient/caregiver education, guidance, and preparedness | Patients and caregivers understand what care is being given and they know what to expect | Education and information for caregivers | Preparing for and accepting death (38%) | |
| Caregiver empowerment through preparedness, education, and knowledge of expectation | Involving and supporting the family (36%) |
Some source themes span multiple synthesized themes (as indicated).