Geralyn Hynes, Ussher Associate Professor in Palliative Care, School of Nursing and Midwifery, Trinity College Dublin, Ireland, explains the background to a longer article that is published in the May/June edition of the European Journal of Palliative Care.
We were commissioned to evaluate palliative care development in Ireland. 1 We were interested in how palliative care had developed since 2001 when a report by the National Advisory Committee on Palliative Care report was adopted by the government of the day as palliative care policy. We wanted to get a picture of palliative and end of life care development across regions and different healthcare settings including those that did not have ‘in-house’ specialist palliative care teams. We interviewed healthcare professionals and administrators from hospital, community and residential care settings in addition to members of specialist palliative care teams.
Our evaluation found an increase in the number of and uptake in palliative and end of life care education programmes aimed at healthcare professionals working across different services, ranging from hospice and specialist palliative care through to acute medicine, chronic disease programmes, community care and care of older persons. Basic level education programmes address the concept of palliative care, adopting a palliative approach to care and the role of specialist services.
This interest and uptake is encouraging though the impact on care remains to be fully understood. The demand for these programmes reflects a broad desire for improving end of life care across different healthcare settings. However, at individual patient and service level, what do these healthcare professionals and specialist palliative care teams expect from one another and how are these expectations negotiated?
Specialist palliative care is now well embedded in the fabric of specialist groups and services in Ireland’s health system. Palliative care is unique in attempting to be a distinct specialty for other services while seeking to establish basic level knowledge and skills within other services. In policy terms, this means that palliative care has a foot in specialist and non-specialist camps.This was recognised in the Irish health service reform strategy which has positioned specialist palliative care as an umbrella programme for other services.
However, in Ireland, the interface between specialist palliative care teams and other services is primarily negotiated through the normal doctor to doctor referral process for individual patients. Healthcare professionals from community and residential care settings were seeking to have a different kind of interface that would enable service development with support from specialist palliative care. Such support would require specialist palliative care teams to become more fully engaged with the local contextual needs of individual services. Perhaps this calls for a new stage of palliative care development and one which focuses on different ways of working with local care settings.
1. McCarron M, Higgins A, Larkin P, et al. Evaluation of the Programme to Support Palliative and Hospice Care in the Republic of Ireland: Final Report. Dublin: Trinity College Dublin, 2012.
Find out more…
The article to which this post relates, ‘Challenges in increasing regional equality in palliative care service provision in Ireland’, by Peter May, Geralyn Hynes, Philip McCallion, Sheila Payne, Agnes Higgins, Phil Larkin and Mary McCarron is published in the May/June 2013 issue of the European Journal of Palliative Care (vol. 20, issue 3).
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