Providing holistic end-of-life care for people with a history of problem substance use: a mixed methods cohort study of interdisciplinary service provision and integrated care.

Publisher: BioMed Central Country of Publication: England NLM ID: 101088685 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-684X (Electronic) Linking ISSN: 1472684X NLM ISO Abbreviation: BMC Palliat Care Subsets: MEDLINE

Original Publication: London : BioMed Central, [2002-

Terminal Care* ; Hospice Care* ; Substance-Related Disorders*/therapy ; Delivery of Health Care, Integrated*; Humans ; Cohort Studies

Harmful use of illicit drugs and/or alcohol is linked to life-limiting illness and complex health and social care needs, but people who use substances and have complex needs do not receive timely palliative care and fail to achieve quality standards for a good death. They and their families often require support from multiple health and social care services which are shown to be poorly integrated and fail to deliver interdisciplinary care. This study aimed to identify the existing barriers and facilitators within and between services in providing this population with a good death. Using a mixed methods approach of survey, focus groups and semi-structured interviews, we explored the perspectives of practitioner and management staff across a range of health and social disciplines and organisations in one combined authority in a large city in the north west of England. Our findings indicate that practitioners want to provide better care for this client group, but face structural, organisational and professional boundary barriers to delivering integrated and shared care. Differences in philosophy of care, piecemeal commissioning and funding of services, and regulatory frameworks for different services, lead to poor and inequitable access to health and social care services. Ways forward for improving care are suggested as bespoke hostel-based accommodation for palliative care for this client group, and specialist link workers who can transcend professional and organisational boundaries to support co-ordination of services and support. We conclude that it is no longer adequate to call for more training, better communication and improved joint working. Complex care at the end of life requires creative and cohesive systemic responses that enable multi-disciplinary practitioners to provide the care they wish to give and enables individuals using substances to get the respect and quality service they deserve.
(© 2024. The Author(s).)

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NIHR 200054 National Institute for Health and Care Research; NIHR 200054 National Institute for Health and Care Research; NIHR 200054 National Institute for Health and Care Research; NIHR 200054 National Institute for Health and Care Research; NIHR 200054 National Institute for Health and Care Research

Keywords: Complex needs; End-of-life; Homeless; Integrated care; Interdisciplinary care; Palliative care; Shared care; Substance use

Date Created: 20240401 Date Completed: 20240402 Latest Revision: 20240403

20240403

PMC10983728

10.1186/s12904-024-01416-4

38556868