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

Background. Studies indicate problems between different professional groups working with palliative care and the organisation of palliative home care at nursing homes. The purpose of this study is to examine international experiences and cooperative development initiatives regarding the organisation of community palliative care services. Method. The study has been carried out as a literature study based on bibliographic searches in international databases with selected key words. Results and Conclusion. The study of the literature identified 19 studies described in 20 articles that relate to development efforts and interventions regarding the organisation of palliative care in communities. Nearly, all of the studies were based on health care professionals' assessments of users (the relatives). However, it is unknown whether or how patients and relatives experience a positive effect of the interventions. The literature study shows that it is a great methodological challenge to complete and evaluate studies concerning organisation and cooperation using methods that make the results useful for others. 1. Introduction After many years of focus on the development of specialised palliative efforts, attention has begun to increase, both in Denmark and internationally, on the need to develop general efforts as well, where many of them take place in communities. This development stems particularly from organisational conditions and competencies [1–3]. Studies [4–8] indicate problems between different professional groups working with palliative care and the organisation of palliative home care. The challenges concern, for example, palliative care domains that necessitate specialised competencies, showing respect for the competencies of other health occupations and individuals. Other challenging issues include improved interdisciplinary collaboration and more efficient circulation of information between care settings (e.g., palliative home care teams and/or GPs, district nurses, and hospitals), improved accessibility, continuity and quality of care, and services to patients at the end of life, as well as shared GP and district nurse visits to families at home. Proactive planning from the beginning of the palliative process and clear distribution of tasks are also needed. Studies of nursing homes (NHs) [9, 10] also indicate problems concerning management, cooperation, communication, and shared care between professional groups. Dying people deserve good care (also meaning good continuity of care). But the above-mentioned publications show that there are ostensibly