[Quality of care in specialized palliative homecare from the provider perspective: A qualitative study]

Abstract

Background: Since its introduction in 2007, the quality of care in specialized palliative home care (SAPV) is being measured using the patients' perspective. The perception of beneficial or inhibiting factors on the quality of care from the perspective of care providers received only little attention.

Objective: To investigate the factors that promote or impede the quality of care in SAPV from the care providers' perspective.

Methods: Within the framework of a transregional qualitative study, 113 problem-centered interviews were conducted on-site at 10 SAPV providers with their staff as well as their network partners. Grounded theory methodology was used for data curation and analysis.

Results: The factors that are perceived as either enhancing or inhibiting the quality of care largely depends on the culture of care of the individual SAPV provider. For participating doctors, nurses and psychosocial professionals, successful performance is associated with good symptom control, participation of relatives and the achievement of certainty of action and of interpretation by means of 'good' decision-making procedures. Problematic performances are linked to a lack of time resulting in restlessness and especially in disagreement between the parties involved in the provision of care as well as to the denial of death.

Conclusions: The results of the study show that the perceived strategies, interpretations and evaluation categories, which are associated with good quality of care, are very heterogenous. On the basis of qualitative data, they do, however, follow three typical patterns in terms of cultures of care: proceduralism, holism and dualism.

Keywords: Culture of care; Homecare; Palliative care; Palliativversorgung; Qualitative Studien; Qualitative studies; Quality of care; SAPV; Versorgungskultur; Versorgungsqualität.