کار گروهی در مراقبت های اولیه: صلاحیت های مکمل پرستاران کارآموز و متخصص آنکولوژی Teamwork in primary palliative care: general practitioners’ and specialised oncology nurses’ complementary competencies

Background Most palliative patients want to spend their end-of-life at home or close to home [1, 2], and many family members prefer to care for them at home [3]. Particularly in rural areas, generalists such as general practitioners (GPs) and district nurses (DNs) provide palliative home care. Most GPs see this as challenging, important and rewarding work [4–8]. Studies on how well GPs deliver palliative care have found a mixed picture [9]. Palliative care offered in teams of GPs and nurses had better clinical outcomes than that provided by GPs alone. GPs wanted more training in relieving pain and other symptoms [10, 11] and some nurses wished for improvement of GPs’ skills [12]. Publicly employed district nurses and small practices of usually self-employed GPs make up the backbone of primary care in Norway. The region of Northern Norway mainly consists of rural areas and a relatively small population of 500.000 people. Primary care is in the hands of 87 different local health authorities. Specialist care is mainly located in 11 hospitals, mostly small ones. About half of the local authorities have employed nurses with a postgraduate diploma in oncology nursing, including palliative care, hereafter called oncology nurses (ONs). They have become key workers in primary palliative care and in the supervision of district nurses [13]. Being specialised, their competence may be regarded as superior to that of GPs in some fields. Despite palliative home care requiring interprofessional collaboration, there is sparse research on such teamwork in the community [14]. GPs are often portrayed as if they were working solo with their palliative patients [15]; however, GPs often prefer to work in local palliative teams with nurses and other trusted care providers, if available [11, 16]. Hierarchical doctor-nurse relationships might persist in such teams [17], but not always [18]. There are few studies of how specialised nurses collaborate with, supervise and teach general practitioners, and vice versa [19–21]. Part of a larger study about rural palliative care, this paper aims to explore how rural GPs and ONs experience their roles and their collaboration in palliative care, including perceived barriers to their cooperation.