Skip to 0 minutes and 9 secondsFinally, I asked each of the six experts-- what essential components should be in place for integrated palliative care? Here are their responses. In Germany, we have seen the transition from pioneer stage to implementation in the regular health care service. This also means that there is an increasing amount of competition and economic pressure. From this perspective, integration requires a lot of trust in all the collaborators-- developing trust and high transparency at the local and regional palliative care networks and open and bilateral collaboration of specialist services with GPs and other health care providers on the basic palliative care level, are prerequisites of integrated palliative care.

Skip to 0 minutes and 56 secondsWell, to reach a real coordination amongst clinical, organisational, administrative, and service aspects to ensure they continue to occur between all actors involved in the current network, I think that there is a need for training on both what palliative care is and how it is performed at the primary level and at specialised levels. I'm not thinking about all health professionals delivering palliative care but having a notion on what it is. So when the time has come to identify the need for it, it is natural to access palliative care units. This would ideally be addressed at the undergraduate level in universities by including a mandatory subject for all health-related students.

Skip to 1 minute and 40 secondsMore specifically, I would think, in creating support structures for palliative care, integrating palliative care in the portfolio of services, creating assessment indicators, and providing a set of documents for proper management, such as guidelines and pathways. Much developmental work has been done since palliative care was introduced in our country, and we are proud to have reached a qualitative high level of care. However, we are not satisfied. Not everyone receives the care he or she needs. People still die in other places than we would have wished for.

Skip to 2 minutes and 15 secondsAnd for people with other diseases than cancer-- for example, COPD, chronic heart failure, or people with special needs because of intellectual disabilities, psychiatric problems, et cetera-- there still is a lot of ground to cover. Integration on a different level is needed for this. Sometimes, well-constructed integrated palliative care initiatives are not structurally embedded into participating organisations or in the regional health care system. Most of the time, integrated palliative care initiatives in the Netherlands are the results of long-standing time and attention from passionate professionals with the aim of care improvements of the patients they know so well. Integration in financial systems often is lacking.

Skip to 3 minutes and 4 secondsBecause of this, sometimes good palliative care initiatives, which are highly valued by patients and informal care providers, have been withdrawn because of new regulations or priorities. I feel that, for the sake of the long-term existence of integrated palliative care initiatives, these financial issues must be tackled. There is still a challenge with regard to collaboration between palliative care and medical specialist disciplines like oncology, cardiology, and pulmonology. Integrating palliative care early in the disease trajectories of patients who visit these specialists will also yield profits on the level of quality patient care.

Skip to 3 minutes and 48 secondsI believe that, for integrated palliative care to take place, policies, regulations should be in place as a fundamental element to recognise and require palliative care to be the part of health care and social services. Also, care providers of different specialties should have the knowledge and information about the availability of services and work closely together on primary, secondary, and tertiary level of care to assure the continuity of care for those patients and families with palliative care needs across the services. The essential elements of integrated palliative care include collaborative working with professionals across different sectors such as health and social care, across primary care, and hospital care.

Skip to 4 minutes and 37 secondsTransitions in place of care are common in the final year of life-- for example, home to hospital and back home again or to a nursing home. The successful coordination of care between these settings-- calling on the resources of the NHS, social services, and volunteers-- is the essence of integrated palliative care.

Essential components of palliative care

Here, Nancy asks the speakers about the essential components that need to be in place for integrated palliative care.

The discussion addresses a number of factors including:

  • the importance of trust and collaboration between and across palliative care networks and healthcare providers
  • mandatory palliative care training for healthcare professionals
  • the financing of palliative care
  • the broadening of services to include patients with non-cancer diseases and conditions
  • the prioritisation of palliative care within healthcare policies and regulations

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This video is from the free online course:

Palliative Care: Making it Work

Lancaster University