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

BackgroundSocial homecare workers are crucial in the provision of end-of-life care but are not part of the healthcare multidisciplinary team. Little is known about why they are excluded within interprofessional working practices. AimTo explore experiences of delivering and receiving end-of-life homecare, from multiple perspectives including HCWs and managers, people receiving care, carers, and social and healthcare practitioners. DesignA qualitative multiple case study adopting a unique approach across three diverse sites 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 Bronfenbrenners ecological theory was used to inform the analysis. Setting/Participants133 participants, were recruited from three economically and culturally different geographic areas within England. ResultsAlthough examples of good practice were seen, common barriers to collaboration between other practitioners and homecare workers were also identified. These included: lack of healthcare practitioner training on homecare workers role and its value/importance, lack of direct communication systems, gatekeeping of communication by managers, asynchronous working practices, one-sided communication, and restricted access to respective documentation and systems. ConclusionThe homecare worker role was often poorly understood, undervalued, and with inadequate communication and interaction between practitioners, potentially impacting on quality of care. Collaborative practice is necessary for continuity of provision of high-quality care, but our findings indicate this was often absent due to knowledge, professional, and organisational barriers. Further research should explore suggested strategies to address the barriers identified. What is already known about this topic?O_LIHomecare workers provide a crucial service to people receiving care at end-of-life and wishing to remain in their own homes C_LIO_LICollaborative working between social and healthcare services improves care provision. C_LI What this paper addsO_LIBarriers to communication led to ineffective collaborative working, including lack of direct communication systems with gatekeeping by managers, asynchronous working practices, misperception of reactive one-sided communication, and restricted access to respective documentation. C_LIO_LIHealthcare practitioners often had poor knowledge of and undervalued the homecare worker role, exacerbating poor communication and collaboration. C_LIO_LIExamples of good practice and potential solutions to barriers to interprofessional working C_LI Implications for practice, theory or policyO_LIHealthcare practitioners require training to better understand, recognise and appreciate the role of homecare workers C_LIO_LICommunication barriers should be addressed to enable the homecare worker to contribute effectively to the multi-disciplinary team. C_LIO_LIThe homecare workforces role in providing high quality end-of-life care will remain constrained without wider professional and societal acknowledgement of its value. C_LI