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Common care practices among effective community-based specialist palliative care teams: a qualitative study
  1. Hsien Seow1,2,
  2. Daryl Bainbridge1,
  3. Melissa Brouwers1,2,
  4. Deanna Bryant3,
  5. Sue Tan Toyofuku4 and
  6. Mary Lou Kelley5
  1. 1 Department of Oncology, McMaster University, Hamilton, Ontario, Canada
  2. 2 Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
  3. 3 Cancer Care Ontario, Toronto, Ontario, Canada
  4. 4 IDEO, Long Beach, California, USA
  5. 5 School of Social Work & Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
  1. Correspondence to Dr Hsien Seow, Department of Oncology, McMaster University, Hamilton ON Canada, Escarpment Cancer Research Institute, Hamilton ON Canada Juravinski Cancer Centre 699 Concession St. Rm 4-229, Hamilton ON L8V 5C2, Canada; hsienseow{at}


Objective Evidence has shown that, despite wide variation in models of care, community-based specialist palliative care teams can improve outcomes and reduce acute care use at end of life. The goal of this study was to explore similarities in care practices among effective and diverse specialist teams to inform the development of other community-based teams.

Methods Interviews with 78 providers and administrators from 11 distinct community-based specialist palliative care teams from Ontario, Canada were conducted. Interviews were audio-recorded, transcribed and analysed using an inductive approach to identify common themes.

Results 3 key themes across all teams emerged. First, the distinct models of care were generally summarised into 3 models: primary care and specialist providers either collaborated by transferring, sharing or consulting in care. Second, teams explicitly or implicitly followed 7 common care practices related to: specialised expertise 24/7; intrateam communication; timeliness; physical symptom and psychosocial–spiritual management; education; peace and fulfilment; and advocacy for patient preferences. Third, all teams emphasised the importance of team building, even more than using clinical tools and processes.

Conclusions Despite wide variation in models of care among community-based specialist palliative care teams, this large qualitative study identified several common themes in care practices that can guide the development of other teams.

  • Palliative care
  • Home care
  • qualitative
  • interprofessional team
  • integration

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  • Contributors HS and DBa were involved in study design, data collection, data analysis, writing of draft manuscript, review of draft and final manuscript. MB and MLK were involved in review of draft and final manuscript. DBr and STT were involved in study design, data collection, data analysis and review of final manuscript.

  • Funding The authors gratefully acknowledge funding received for this study from the Ontario Ministry of Health and Long Term Care (contract number 2011-0006) and the Canadian Institutes of Health Research (grant number 115112).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Hamilton Health Sciences/McMaster University Research Ethics Review Board, Ontario, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.