A Qualitative Investigation of Coordination inSwiss Palliative Services: A Quest for Quality in Care

Ensuring high quality palliative service provision is of upmost importance. In the dawn of the recent pandemic, effective palliative care services have never been more crucial for the 21stcentury. The relationship between effective care coordination and high-quality palliative care provision is highly recognized in literature and supported by empirical findings. However, good coordination of care proves difficult to provide in the demanding context of palliative care and the care coordination of services are often poorly evaluated. Moreover, little is known about care coordination in palliative care services, whilst even less is understood about care coordination between primary and specialized palliative care services. Specifically, in Switzerland, there is an even deeper need for improving coordination of care as the implementation ofpalliative care is highly fragmented approaches to palliative care service provision, according to regional and cantonal preferences. Thus, high quality service provision in palliative care in Switzerland cannot beguaranteed. In view of the stateof research in the field, three interrelated qualitative interview studies were carried outto explore aspects of coordination and quality of care in both primary and specialized palliative care settings. All studies are based on qualitative interview data from palliative care professionals in palliative care settings in Switzerland. The third study additionally includes data from relatives of palliative patients. All studies were based onpalliative care services in four Swiss cantons: Ticino, Vaud, Luzern and Basel-City. These cantons were selected to reflect the rural and urban regions of Switzerland as well as diversly developed policy contexts for palliative care in Switzerland. The studies not only addressexisting gaps in literature butare also built upon the findings of each study. This was done toensure that contemporary issues that were indicated in the data were addressedand that important areas for future research were not overlooked. The first study sought to investigate challenges to coordination between primary and specialized palliative care services in Switzerland. The findings of this study shed light on many important, multifaceted challenges to coordination. Amongst these challenges was apparent confusion concerning professional roles, particularly in the context of primary palliative care services. In response to this finding, the second study sought to build on the findings of the first study by exploringwho professionals believeto playa key role in palliative home care. The results from this research strongly demonstrated that there was considerable ambiguity concerning the care coordinator role. Based on these results, and the assumptionthatclearly designated care coordinators are considered a prerequisite for effective coordination and high quality of care, the last study explored perceptions of quality of care in palliative home care. This was donewith consideration of the perspective of palliative relatives, as well as the perspectives of palliative professionals, in order to facilitate a broaderunderstanding of quality in palliative care. All findings of the studies contribute substantially, both independently and collectively, to the state of research in palliative care in Switzerland. Importantly, they indicate specificareas for the improvement for policy, practice and future researchin the field of palliative care. This cumulative dissertation summarizes the compilation of the scientific manuscripts that were a result of these studies. The summation of these works is of value to; fellow scientific researchers in the scope of public health, policy-makers and palliative care professionals, as well as family care givers in palliative care contexts