KWASA bottleneck analysis: experienced bottlenecks of healthcare providers with regard to signaling and decision making in the palliative phase

Background/aims: Care providers appoint a seamless collaboration essential to ameliorate the quality of palliative care. Signaling in the Palliative Phase (SPP) and Decision-making in the Palliative Phase (DPP), are being further developed into an integrated digital working method to improve collaboration in the KWASA study. This bottleneck analysis of current practice forms the basis for development and implementation of an integrated working method.
Methods: A cross-sectional observational study with a convenience sample of physicians, nurses, chaplains and paramedics working in primary care and nursing homes. A digital survey was developed together with experts and send in June 2019. Data analysis is based on descriptive statistics and thematic analysis.
Results: 306 care providers (41%): 63% nurses, 18% physicians, 17% paramedics and 2% chaplains. Although 50-94% respondents consult with different disciplines structure and continuity seem to be lacking. Nurses, chaplains and paramedics are in need of more involvement from other disciplines. Steps of clinical reasoning are not easy to follow for all care providers (12-20%), evaluation and adjustment of the policy are not implemented structurally: 14-43% make sometimes/never agreements who and when to measure the effect of care; 5-29% sometimes/never evaluate care. Familiarity with SPP and DPP varies widely (0-100%). Bottlenecks in use are: time, structural commitment, complexity and competence.
Conclusions: Although signaling and decision-making support a clear structure of the palliative care process, this structure and continuity do not appear to be optimal in practice. Multiprofessional collaboration is important according to respondents, a structured approach is missing. An integral approach to symptoms and the evaluation of policy decisions contribute to improving appropriate palliative care. Funding: the Netherlands Organization for Health Research and Development.