Academic journal article Care Management Journals

Factors of Good Collaboration in Home-Based End-of-Life Care: A Questionnaire Survey of Japanese Home Care Nurses, Home Helpers, and Care Managers

Academic journal article Care Management Journals

Factors of Good Collaboration in Home-Based End-of-Life Care: A Questionnaire Survey of Japanese Home Care Nurses, Home Helpers, and Care Managers

Article excerpt

Good interprofessional work (IPW) is essential to provide quality home-based end-of-life (EOL) care. The purpose of this study was to explore the factors of "good collaboration," as evaluated separately by home care nurses (HNs), home helpers (HHs), and care managers (CMs). The relationship was examined between their evaluation of good collaboration and their recent actual experience of interprofessional collaborative work for a home-based EOL case. The questionnaire was returned nationwide by 378 HNs, 305 HHs, and 476 CMs, and data were collected on 177 EOL cases from HNs, 84 cases from HHs, and 123 cases from CMs. Evaluation of good collaboration by HNs was associated with working with a CM with whom they had multiple collaborative experiences, the client being independent for their toileting until just before dying, and sharing information regarding the client's EOL decision with an HH 1 month before dying. Evaluation of good collaboration by HHs was associated with working at an agency that collaborated with fewer CM agencies and working at an agency that allowed staffto visit dying clients. Evaluation of good collaboration by CMs was associated only with the client being dependent for toileting. Our results highlighted the characteristics of how each professional seeks to collaborate depending on their preparedness, contexts, and resultant expectations toward other professionals when entering the IPW for home-based EOL care. To promote good IPW for home-based EOL care further, professionals need to understand these differences among ourselves and try to meet others' expectations.

Keywords: interprofessional work; home care; palliative care; older adults

Approximately 40%-50% of the public, as well as persons with cancer, prefer to stay at home until the end of their lives in and out of Japan (Higginson & Sen-Gupta, 2000; Tiernan, O'Connor, O'Siorain, & Kearney, 2002; Yamagishi et al., 2012). Recently, there has been an increase in medical expenditures because of the rise in the older population and advances in medical technology, and this prompted the Japanese government to begin emphasizing that people at the end of their lives should be able to receive satisfactory care at home or in another nonhospital residence for as long as the individual wanted (Monden, 2013). Under these circumstances, home-based end-of-life (EOL) care has become a priority issue in health care from both economical and quality of life points of view.

However, the actual rate of people who died at home is only 13% of overall deaths (Ministry of Health, Labour and Welfare [MHLW], 2012). This low rate of home deaths has not changed for a decade in Japan (MHLW, 2012), whereas the number of people with cancer dying at home has increased in other countries such as the United States or England (Decker & Higginson, 2007). It is important to promote home care in general, and we particularly must learn how to successfully care for persons at home until the end of their lives.

Good collaboration among professionals, interprofessional work (IPW), is essential to provide quality EOL care (Alsop, 2010; Devlin & McIlfatrick, 2009; Pellett, 2009). Home-based EOL care requires various professionals such as physicians, home care nurses (HNs), or home helpers (HHs). Care managers (CMs) are also indispensable for managing service use under the long-term care insurance (LTCI) system. IPW has been focused on rather recently in health care literature (Bainbridge, Brazil, Krueger, Ploeg, & Taniguchi, 2010; Tang, Chan, Zhou, & Liaw, 2013). Patel, Pettitt, and Wilson (2012) proposed a conceptual framework for professional collaboration that includes a range of domains, including the human or environmental, but the validity of the model has yet to be confirmed. Tang et al. (2013), reviewing research articles on collaboration between hospital physicians and nurses, concluded that we need further studies to develop an instrument that can measure collaboration and intervention methods to improve IPW. …

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