The status of a public health approach to palliative care at New Zealand hospices

Abstract

Background: There is growing international support for a public health approach to palliative care; however the status of the movement in the local New Zealand context is unknown. Aim: To explore the uptake, nature and understandings of a public health approach to palliative care by hospices in New Zealand. Methods: A mixed method study using a convergent parallel design was conducted. In phase 1 quantitative data were collected using an online survey of hospice leaders, and in phase 2 qualitative data were generated from semi-structured telephone interviews with a sub-sample of phase 1 participants. Data from the survey were analysed using appropriate statistical techniques. Transcripts of the telephone interviews were analysed using thematic analysis. The findings from each phase were then triangulated to check for congruency. Sample: Fifteen leaders (12 chief executive officers, and three senior managers) at New Zealand hospices participated in the online survey, representing a response rate of 54%. Ten of these participants took part in a semi-structured telephone interview. Results: Analysis of the quantitative results confirmed that a public health approach to palliative care was a current priority at 60% of New Zealand hospices. However, both phases of the study demonstrated that community engagement, one of the chief outworkings of a public health approach to palliative care, was incompletely understood and practiced. Furthermore, the qualitative results showed that, while this approach is supported, there are significant barriers to implementation, including paternalism, resource constraints, adequate evaluation, and incomplete understanding of key concepts such as social networking and community engagement Conclusion: This study is the first to explore the extent to which a public health approach to palliative care is supported by hospices in New Zealand. The unique new findings have important implications for practice. If the model is to be implemented to maximum benefit, further conceptual clarity of the key tenets is needed. In addition, addressing the barriers to implementation identified by this study will need to be prioritised by hospice leadership.