Palliative care consultation services – bridging gaps with general healthcare teams

Background: To ensure equitable access to palliative care, collaboration between specialist palliative care providers and general healthcare teams is essential. Generalist-level palliative care should be integrated into routine care for patients with palliative needs, while specialist consultation services can support and enhance this care.

 

 Consultation teams act as a bridge between specialist and generalist palliative care, yet previous research—primarily from the US and UK—highligh leftts challenges such as unclear roles and misconceptions about palliative care. There is limited knowledge about which patients receive consultations at a general-population level, raising concerns about equity. Additionally, effective models for early integration of palliative care remain underexplored.

 

 

Approach: This thesis aims to deepen understanding of how palliative care knowledge can be translated into general healthcare and what factors influence integration through consultation services. It comprises four sub-studies that: 1) map knowledge translation strategies for palliative care, 2) explore consultation practices, 3) investigate factors associated with access to consultations, and 4) examining a quality improvement initiative for early integration of palliative care in surgical care. Using an interpretive description design, the research applies both qualitative and quantitative methods.

 

Results: The findings identify macro-, meso-, and micro-level factors that influence the integration of palliative care through consultation services. In line with international research, cancer diagnosis emerged as the dominant factor associated with access to consultations in Sweden, highlighting persistent inequities based on diagnosis. The consultation practice is shaped by a bottom-up approach, largely due to weak policy frameworks, which compels consultants to actively promote their services to other healthcare providers.

 

Successful integration requires attention to several key factors. At the national level, clear yet context-adaptable policies for palliative care consultations must be established to ensure that patients in need can access these services through their healthcare provider, regardless of diagnosis. In co-created development projects, it is essential to clarify expectations regarding the consultant’s role and core palliative care concepts. Furthermore, the internal organisation of palliative care within both specialist and generalist teams must be considered, alongside the need to address diagnosis-specific patient needs and adapt to the broader palliative care infrastructure.

 

Implications: These insights offer valuable guidance for future research and initiatives aimed at strengthening consultation services and advancing the integration of palliative care across healthcare settings.