Multidimensionality in Hospice Care

Abstract

Background: Palliative care is multidimensional and includes physical, psychological, social, and spiritual dimensions. Hospices provide specialist palliative care. Limited research has been performed in hospice care. Therefore, there is a lack of insight into this topic. Objective: To gain insight into the current practices of multidimensional care provided by multidisciplinary teams in hospices and to gain insight into current hospice care in the Netherlands. Method: A mixed methods, sequential, explanatory design was performed from January to July. Results: It was concluded that nurses often report on all four dimensions. The multidisciplinary consults scored high on all dimensions and the spiritual dimension requires more attention from all disciplines. Participants in focus groups said that more attention was paid to multidimensionality than that which was found in patient records; however, this attention was not always reported. Interdisciplinary teams are desirable when all disciplines are responsible for attending to each of the dimensions. Conclusions: Multidimensional care is not always reflected in patient records. The spiritual dimension is lacking, because it is considered a privacy issue. Structure is necessary to provide care according the steps of clinical reasoning, and to give attention to all dimensions. This structure must fit into hospice care and the organisation to be supportive. Most hospices employ multidisciplinary teams; however, interdisciplinary consults are lacking. Education is required to gain the competencies necessary to give palliative care. Recommendations: To achieve data saturation, more research is needed. There is much gained when hospice facilities start working together with all disciplines present during MDC. Also, more structured is needed in reporting methods. Care providers that use structured methods can teach this to others. Furthermore, attention must be given to the education levels of these professionals to provide a high standard of care and develop competencies in clinical reasoning and spiritual care.