16 Cantonal differences make it difficult to form regional palliative care networks

Various actors in palliative care, such as family doctors, specialists from hospices and nursing homes, mobile palliative teams, social workers, pastoral care workers and relatives of palliative patients were interviewed about central aspects of palliative care. In addition to the structural preconditions for palliative care, central aspects of care processes, the coordination of care services and important dimensions of care quality in the field of palliative care were analyzed. A large number of guideline-based interviews and a nationwide survey of palliative care professionals served as the basis for the data. On this basis, a number of recommendations were formulated for policy-makers, for training and further education, and for day-to-day care in order to improve cooperation and coordination in palliative care.

Palliative care networks are based on the interaction of various interdependent players in the health system. As yet, neither collaboration nor coordination within these networks has been studied in Switzerland. Validated knowledge about successful models in this field is required in order to promote access to palliative care for the whole population and to avoid unnecessary hospitalization.

The aim of the study was to analyze the collaboration and coordination of service providers both within primary palliative care and between this field and specialized palliative care. In addition, successful forms of local/regional care provision and the prerequisites for successful provision were identified in consideration of their impact on patients.

Switzerland has made considerable progress in palliative care in recent years. Nevertheless, there is still great potential for optimization. At present, palliative care is organized differently in each canton, which makes it difficult to form regional networks and has a negative impact on the quality of services. Inter-professional cooperation is also poorly developed, and the coordination of care and medical services within outpatient palliative care and at the interface with specialist care is challenging. Finally, the largely coordinating role of nurses remains informal, although they generally act as key personnel within and between provisional areas, especially in home palliative care. The reasons for these gaps and mismatches are manifold; they are due in part to a lack of financial cooperation, but also to "collaborative thinking" on the ground.

Significance of the results for practice

The study generated empirical knowledge and recommendations for policy makers in the Swiss health care system to improve collaboration and coordination in primary palliative care and beyond. In close cooperation with family physicians, a concept and agenda for the implementation of "interprofessional quality circles" for members of different health care professions and for support services was developed.

Coordination and collaboration in primary palliative care. Palliative care networks in Switzerland.