School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
BMC Palliat Care. 2013 Aug 29;12(1):32. doi: 10.1186/1472-684X-12-32.
This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind.
Using qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams.
Sustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward.
This study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions.
本文聚焦于现有的姑息治疗团队，这些团队在共同照护模式下提供居家照护。在本研究中，遵循 Evashwick 和 Ory（2003）的定义，可持续性被理解为随着时间的推移继续开展项目的能力。了解影响团队可持续性的因素以及减轻这些因素的方法对于提高这种团队服务提供模式的持久性和服务质量至关重要。
本研究使用定性数据进行访谈，旨在实现两个目标：（1）探索影响团队在三个不同层面可持续性的因素；（2）根据本研究的结果，提出一系列建议，以促进姑息治疗团队的可持续性。
可持续性从内部和外部两个角度进行了概念化。外部可持续性概述提供后，对所有参与者群体的数据进行合并，结果表明团队的可持续性在很大程度上取决于地方（社区）、区域（地方卫生整合网络或 LHIN）和省级的行动者和组织。这三个层面不是自成一体或单一的实体，而是相互关联的。内部和层面之间的整合与协作是必要的，因为如果没有省级的支持，社区的能力将不可避免地达到极限，而省级为 LHIN 提供资金。虽然社区会一直倡导为团队提供支持，但从长远来看，他们将需要 LHIN 和省级的额外支持。省级有通过正式策略来支持团队的权力和能力。建议是根据规模提出的，以便更好地说明行动者和组织如何向前推进。
本研究可以为特定战略提供信息，以改善基于团队的姑息治疗居家照护的提供，同时为其他司法管辖区的团队提供服务提供和可持续性方向。
