Here is the standardised PICO analysis for the fifty-ninth uploaded article:
Full Title
Inter-organisational Collaboration in Palliative Care Trajectories for Nursing Home Residents: A Nation-Wide Mixed Methods Study Among Key Persons
Authors: Sofie Hermans, Aline Sevenants, Anja Declercq, et al.
Journal: International Journal of Care Coordination, 2019; 22(2):69–80
Type of Study
Sequential mixed-methods study combining a national survey and focus groups with key stakeholders across 15 Flemish palliative care networks
PICO Summary
Population (P)
- Key persons (n = 308) from nursing homes, hospitals, and home care organisations across Flanders, Belgium
- Participants included managers, nurses, physicians, and network coordinators from the 15 government-recognised regional palliative care networks
Intervention (I)
- Evaluation of collaborative practices in palliative care delivery for nursing home residents
- Collaboration assessed between:
- Nursing homes and home care
- Nursing homes and hospital care
The intervention being studied was the structure and function of the palliative care networks and their effectiveness in fostering inter-organisational collaboration.
Comparison (C)
- Comparison across two collaboration types: NH-home care vs. NH-hospital care
- Also compared interpersonal dimensions (e.g., trust, mutual knowledge) vs structural dimensions (e.g., governance, formalisation)
Outcomes (O)
Quantitative outcomes (survey findings):
- Interpersonal dimensions (e.g., trust, mutual acquaintance, client-centred orientation) rated significantly higher than structural dimensions (e.g., leadership, formalised tools)
- Collaboration with home care was rated more positively than collaboration with hospitals
- Formalisation and governance consistently scored lowest across both collaboration types
Qualitative outcomes (focus group findings):
- Key challenges identified:
- Lack of shared leadership (especially due to GP dominance)
- Poor information exchange and documentation transfer
- Absence of standardised ACP and palliative pathways
- Disparate IT systems and non-aligned legal/privacy protocols
- Palliative care remains misunderstood as “giving up” rather than a proactive philosophy
Recommended priorities to improve collaboration:
- Foster mutual acquaintance to build trust and cooperation
- Establish shared communication infrastructure (e.g., case conferencing, joint IT systems)
- Promote formalisation of good practices, joint decision-making agreements, and shared leadership protocols
- Provide joint intersectoral education across organisational boundaries
- Empower patients and families in ACP to counteract overly medicalised decision-making
Findings Summary
This study reveals a clear imbalance between strong interpersonal goodwill and weak structural systems in Belgium’s palliative care for nursing home residents. It highlights:
- The need for formalised communication pathways
- Importance of cross-sector mutual understanding
- The value of including non-hospital care sectors (especially home care) in planning
- And the critical role of networks as conveners, educators, and agents for change
Although the palliative care networks are over two decades old, they still rely heavily on informal relationships and lack the infrastructure needed for durable, scalable integration.
Conclusion
The study calls for a shift from informal, personality-driven cooperation to structured, policy-aligned, and inclusive collaboration, particularly in ACP, information flow, and shared leadership. These changes are essential for improving care continuity and respecting residents’ wishes at the end of life.
Life In The Slower Lane 
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