Addressing barriers to interprofessional working with homecare workers in community palliative care: Insights from a multi-site qualitative case study.

Abstract

Homecare workers (paid workers without professional qualifications who provide care for people within their own homes) are crucial providers of end-of-life care (the last 6 months of life) but are not part of the healthcare multidisciplinary team. Little is known about the homecare worker role within interprofessional working practices. To explore the experiences of end-of-life homecare provision, from multiple perspectives. A qualitative multiple case study using semi-structured interviews, and the option to create a Pictor chart - a visual diagram of relationships between those involved in care provision. Data were analysed using a reflexive thematic analysis. An adaptation of Bronfenbrenner's ecological systems theory was used to inform the analysis. Homecare workers and managers, people receiving care, carers, social, and healthcare practitioners from three economically and culturally diverse geographical regions within England. 133 participants were recruited (case 1 = 49, case 2 = 34, case 3 = 49). Although examples of good practice were seen, common barriers to collaboration between health and social care practitioners and homecare workers were identified: lack of healthcare practitioner knowledge/training on homecare workers' role and its value, and poor communication (gatekeeping by managers, asynchronous working practices, restricted access to documentation and systems). The homecare worker role was poorly understood and undervalued with inadequate communication and interaction between practitioners, potentially impacting on quality of care. Collaborative practice is necessary for provision of high-quality care, but we found this was often absent due to knowledge, professional, and organisational barriers. Further research should explore suggested strategies to address the barriers identified.