Transitions in palliative care provision across healthcare settings in the U.S. : A grounded theory of interdependence between specialist and generalist palliative care teams

Thelen, Mary and Brearley, Sarah and Walshe, Catherine (2020) Transitions in palliative care provision across healthcare settings in the U.S. : A grounded theory of interdependence between specialist and generalist palliative care teams. PhD thesis, Lancaster University.

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Abstract

Background: Individuals requiring palliative care near the end of life often receive that care in multiple healthcare settings, from both specialist and generalist palliative care teams. There is a need to better understand the processes that take place between the two teams that create or disrupt continuity of palliative care provision. Aim: The aim of this study was to develop a substantive theory of the psychosocial processes that occur between inpatient specialist palliative care teams and generalist teams outside the hospital setting who care for palliative patients after discharge. Methods: Semi-structured interviews were conducted with interdisciplinary clinicians from specialist palliative care teams and generalist healthcare teams in the U.S. Purposeful and theoretical sampling was used to recruit 21 clinicians. Data were analysed using constructivist grounded theory methods including constant comparative analysis of iterative levels of coding, memoing and diagramming, and abductive analysis of the literature. Results: A grounded theory of interdependence identified the psychosocial processes that contribute to team perception and function, and the outcomes of those processes. Specialist and generalist palliative care teams function with different degrees of interdependence in relation to other teams caring for shared patients based on how they perceive themselves as a team. When teams function more interdependently across healthcare setting boundaries, clinicians perceive outcomes to be more positive for patients, families, and themselves. In contrast, when teams function more independently within boundaries, outcomes are perceived to be more negative. Additionally, a team’s self-perception and way of functioning further perpetuate that self-perception and way of functioning over time. Conclusion: This substantive theory contributes new insights into how palliative care specialists and generalists should work and communicate with each other across healthcare settings to provide continuous and collaborative care for patients and families experiencing advanced illness. It provides a theoretical starting point for additional research to explore interventions that impact teams’ relationships and collaboration across healthcare settings.