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Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience

Authors
  • Ebenau, Anne1, 2
  • Dijkstra, Boukje3
  • ter Huurne, Chantal4
  • Hasselaar, Jeroen1
  • Vissers, Kris1
  • Groot, Marieke1
  • 1 Radboud University Medical Centre (Radboudumc), Nijmegen, 6500 HB, The Netherlands , Nijmegen (Netherlands)
  • 2 Salvation Army, Central Netherlands, Zandvoortweg 211, Baarn, 3741 BE, The Netherlands , Baarn (Netherlands)
  • 3 Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, 6500 HE, The Netherlands , Nijmegen (Netherlands)
  • 4 Tactus Addiction Care, Lokatie Ripperdastraat, Ripperdastraat 8, Enschede, 7511 JR, The Netherlands , Enschede (Netherlands)
Type
Published Article
Journal
BMC Palliative Care
Publisher
BioMed Central
Publication Date
Jan 14, 2020
Volume
19
Issue
1
Identifiers
DOI: 10.1186/s12904-019-0502-x
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThere is little information about how healthcare professionals feel about providing palliative care for patients with a substance use disorder (SUD). Therefore, this study aims to explore: 1) the problems and needs experienced by healthcare professionals, volunteers and experts-by-experience (HCP/VE) during their work with patients with SUD in a palliative care trajectory and; 2) to make suggestions for improvements using the quality of care model by Donabedian (Structure, Process, Outcome).MethodsA qualitative study was conducted, consisting of six focus group interviews which consisted of HCP/VE working with patients with SUD in a palliative care phase. At the end of the focus group interviews, participants structured and summarized their experiences within a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Interview transcripts (other than the SWOT) were analysed by the researchers following procedures from the Grounded Theory Approach (‘Grounded Theory Lite’). SWOT-findings were not subjected to in-depth analysis.ResultsHCP/VE stated that within the Structure of care, care networks are fragmented and HCP/VE often lack knowledge about patients’ multiplicity of problems and the time to unravel these. Communication with this patient group appears limited. The actual care-giving Process requires HCP/VE a lot of creativity and time spent seeking for cooperation with other caregivers and appropriate care settings. The latter is often hindered by stigma. Since no formalized knowledge is available, care-delivery is often exclusively experience-based. Pain-medication is often ineffective due to active substance use. Finally, several Outcomes were brought forward: Firstly, a palliative care phase is often identified only at a late stage. Secondly, education and a (mobile) team of expertise are desired. Thirdly, care for the caregivers themselves is often de-prioritized.ConclusionsBetter integration and collaboration between the different professionals with extensive experience in addiction, palliative and general curative care is imperative to assure good palliative care for patients with SUD. Currently, the resources for this care appear to be insufficient. Development of an educational program and social mapping may be the first steps in improving palliative care for patients with severe SUD.

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