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Improving the organization of palliative care: identification of barriers and facilitators in five European countries

机译：改善姑息治疗的组织：在五个欧洲国家中发现障碍和促进者

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Background Interventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care?s complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service. Methods Semi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data. Results Professionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries. Conclusion This study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.
机译：背景技术由于姑息治疗的复杂性和不断变化的特征，改善姑息治疗的干预措施所面临的挑战超出了通常的实施问题。在这项研究中，我们探讨了五个欧洲国家（英格兰，德国，意大利，挪威和荷兰）的医疗保健专业人员在改善其姑息治疗服务的组织方面面临的障碍和促进者。方法与半有针对性的个人访谈和焦点小组访谈是与有针对性地选择的医疗保健专业人员进行的。常数比较法用于分析数据。结果采访了在医院，临终关怀医院，疗养院和初级保健机构中为成年患者提供姑息治疗的专业人员（n = 40）或参加了十次焦点小组访谈（n = 59）。障碍和推动者归纳为16个类别，并分为五个主题：创新，个人专业水平，团体动态，组织环境和当地政治经济环境。尽管确定的障碍和促进者在范围，背景，实力和出身方面有所不同，但来自欧洲不同国家的专业人员共享这些障碍和推动者。结论本研究确定了姑息治疗中组织变革的障碍和促进因素。这些障碍和促进者中的某些障碍是几乎所有国家的专业人员都经历过的，因此是变革的先决条件。了解改变的障碍和促进者将有助于根据个人和组织的需求量身定制组织改进方案。

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