Specialized palliative home care teams : complementary perspectives of team functions and influences on patients and families

Persons with life-threatening illness are increasingly being cared for and dying at home. Palliative care strives to cater to multiple dimensions such as physical, psychosocial and spiritual or existential, and meeting these needs in patients and families requires multiple competencies. Palliative care organizations propose organization and delivery of care in teamwork models; however, teamwork is complex and can be approached from various perspectives. Previous research has identified gaps in palliative care regarding which components of teamwork are most effective. The overall aim of this thesis was to explore perspectives of team function in specialized palliative care teams, among health care professionals, families and patients. Study I entailed translation and cultural adaptation of a research questionnaire. Study II entailed qualitative interviews with health care professionals (n=15) working in specialized palliative home care and Study III interviews with patients (n=6) and family members (n=7). In Study IV, an exploratory design was used. Initially team leaders (n=77) in palliative care reported team function. Next, health care professionals (n=61) reported team development in the group development questionnaire, patients (n=43) reported symptoms in the Edmonton Symptom Assessment System and family members (n=45) reported satisfaction with care in the translated and culturally adapted FAMCARE-2 questionnaire. Results of the studies are: (I) a translated culturally adapted and initially tested Swedish language version of the FAMCARE-2 scale, (II) health care professionals report that competence, communication and organization are crucial components of teamwork in specialized palliative homecare, (III) patients and families report that they experience security and continuity of care due to 24/7 care, sensitivity to changing needs and demonstrating caring, and (IV) specialized palliative home care teams have a core of registered nurses, physicians and social workers. Positive associations were found between team maturity and team effectiveness.

List of scientific papers

I. Klarare Ljungberg A, Fossum B, Fürst CJ, Lundh Hagelin C. Translation and cultural adaptation of research instruments – guidelines and challenges: an example in FAMCARE-2 for use in Sweden. Informatics for Health and Social Care. 2014, Jan 6:1-12.
https://doi.org/10.3109/17538157.2013.872111

II. Klarare A, Lundh Hagelin C, Fürst CJ, Fossum B. Team interactions in specialized palliative care teams: a qualitative study. Journal of Palliative Medicine. 2013;16(9):1062-9.
https://doi.org/10.1089/jpm.2012.0622

III. Klarare A, Rasmussen B,Hansson J, Fürst CJ, Fossum B, Lundh Hagelin C. Experiences of security and continuity of care – patients’ and families’ narratives of palliative home care teams’ work. [Submitted]

IV. Klarare A, Hansson J, Fossum B, Fürst CJ, Lundh Hagelin C. Team type, team maturity and team effectiveness in specialized palliative home care: an exploratory questionnaire study. [Manuscript]