Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Tweekerkenstraat 2, Ghent, B-9000, Belgium.
Strategic Policy Unit, University Hospital Ghent, Corneel Heymanslaan 10, Ghent, B-9000, Belgium.
BMC Palliat Care. 2024 Oct 26;23(1):250. doi: 10.1186/s12904-024-01585-2.
Palliative care is becoming an essential component of healthcare, but there is insufficient research on how integration across different levels of care (micro, meso, and macro) is realized in practice. Without such integration, care may become fragmented, leading to suboptimal patient outcomes. While many studies have explored palliative care models, there is a gap in understanding how priorities for integrated care align across these levels within healthcare ecosystems. Specifically, it is unclear whether key actions at each level are shared, coordinated, and supported effectively, making it difficult to implement sustainable, cohesive care strategies. Our study aims to explore the extent to which important goals (i.e., priorities) are shared across the micro, meso, and macro levels of the palliative care ecosystem in Flanders, Belgium.
We applied a multimethod study using the analytic hierarchy process method (AHP). This consists of three sequential steps: a broad literature search and interviews with Belgian stakeholders (n = 12) to determine the criteria for the organization of integrated care; focus groups (n = 8) with patients, their relatives and caregivers to establish the completeness and relevance of the criteria; and prioritization of the criteria using a questionnaire among 305 Flemish participants (patients, relatives, caregivers and policy makers).
Our findings revealed that integration is imbalanced, with priorities being most emphasized at the micro level (57%), followed by the meso (29%) and macro (14%) level. Functional enablers dominate at the macro (80%) and meso organizational level (67%), while normative enablers are emphasized at the meso professional (67%) and micro level (75%). Effective palliative care requires vertical coordination of these enablers: for instance, transparent communication with patients at the micro level depends on cross-organizational information exchange at the meso level, supported by a unified data system at the macro level.
Achieving integrated palliative care requires deliberate alignment of priorities across all levels of the ecosystem. While each level plays a unique role, palliative care is comprehensive and effective only by sharing both functional and normative enablers across micro, meso, and macro level.
姑息治疗正成为医疗保健的重要组成部分，但对于如何在不同层面的护理（微观、中观和宏观）中实现整合，相关研究还不够充分。如果没有这种整合，护理可能会变得支离破碎，导致患者的治疗效果不佳。虽然许多研究都探讨了姑息治疗模式，但对于在医疗保健生态系统中，各层面的整合护理优先事项如何相互协调，人们的理解仍存在空白。具体来说，不清楚在每个层面上，关键行动是否得到了有效共享、协调和支持，这使得实施可持续、连贯的护理策略变得困难。我们的研究旨在探讨在比利时佛兰德斯的姑息治疗生态系统中，重要目标（即优先事项）在微观、中观和宏观层面上的共享程度。
我们采用了一种多方法研究，使用层次分析法（AHP）。该方法包括三个连续步骤：广泛的文献搜索和对 12 名比利时利益相关者的访谈，以确定整合护理的组织标准；与 8 名患者、他们的亲属和护理人员进行焦点小组讨论，以确定标准的完整性和相关性；以及在 305 名佛兰德斯参与者（患者、亲属、护理人员和政策制定者）中使用问卷对标准进行优先排序。
我们的研究结果表明，整合是不平衡的，优先事项在微观层面上（57%）得到了最强调，其次是中观层面（29%）和宏观层面（14%）。功能推动者在宏观（80%）和中观组织层面（67%）上占主导地位，而规范推动者在中观专业层面（67%）和微观层面（75%）上占主导地位。有效的姑息治疗需要垂直协调这些推动者：例如，微观层面上与患者的透明沟通依赖于中观层面上的跨组织信息交流，宏观层面上的统一数据系统则提供支持。
实现整合姑息治疗需要在生态系统的所有层面上精心协调优先事项。虽然每个层面都发挥着独特的作用，但只有通过在微观、中观和宏观层面上共享功能和规范推动者，姑息治疗才是全面和有效的。
