Understanding Hospital Staff Needs and Perceptions in the Provision of Palliative Care

Purpose:

The primary aim of this study was to investigate hospital staff perspectives and experiences regarding palliative care provision. Secondary aims were to assess staff views about death and dying, their awareness of common causes of death in Australia and their assessment of which patients most warrant a palliative care approach.

Methods:

All medical, nursing, allied health and pastoral care staff working in a large private hospital in Perth, Western Australia were invited to complete a combined quantitative and qualitative survey. The validated survey tool, previously used in other healthcare settings, used a combination of Likert-type scales and open ended questions. Descriptive statistics and intergroup comparisons were made for all quantifiable variables, while formal content analysis was used for text responses. In addition, four focus groups were held across different hospital areas allowing for more detailed discussion of the provision of palliative care.

Results:

We had a pleasing 51% response rate (N = 302) with most staff reporting only working knowledge of palliative care but clinical proficiency in symptom control. Confidence in palliative care provision was lower amongst nursing than medical staff but educational needs were similar. Cancer diagnoses were consistently overestimated, and dementia and chronic obstructive pulmonary disease underestimated, as the most common causes of death.

Conclusion:

Our study suggests that although clinical staff expressed confidence regarding symptom management in palliative care, they lacked understanding of the patients in whom a palliative approach could be applied and sought further education in areas such as end-of-life communication and ethical issues.  Specific training and clinical interventions in palliative care provision would seem to be needed and justified.