Towards consensus on specialist expertise in palliative care in the Netherlands – a modified Delphi study

Abstract

Abstract Background In the Netherlands, palliative care is provided by generalist healthcare professionals (HCPs). If necessary, specialist palliative care expertise is involved, for example, in managing complex symptoms or challenging family dynamics. The Netherlands Quality Framework for Palliative Care describes the roles of the specialist and expert in palliative care but does not describe the conditions and competencies needed to become one. This lack of clarity hinders the appropriate education of HCPs specialized in palliative care on all professional levels and may affect the quality of palliative care. Objective This study aimed to achieve consensus among HCPs regarding conditions (work experience, education, and role description) and competencies that can provide input for a profile of specialized expertise in palliative care for the nursing and medical professions. Methods We used a modified Delphi study design consisting of three rounds: two written rounds and a round of seven dialogue tables. 396 HCPs participated. They indicated their level of agreement on 37 statements using a 5-point Likert scale. An agreement of 75% or higher was used to indicate consensus. Results Participants from both nursing and medical professions reached a consensus on the necessary conditions for work experience, education, and role descriptions. They also identified essential competencies for healthcare professionals specializing in palliative care. These competencies are structured around the patient journey and include identifying, diagnosing, and signaling the palliative phase; advance care planning, performing, and evaluating palliative care; coordinating and ensuring continuity of palliative care; indicating and guiding the dying phase; and providing aftercare. Moreover, specialized palliative care professionals possess distinctive competencies compared to generalists, particularly in leadership and their driving role in palliative care. They are involved in caring for patients and relatives with complex palliative care needs directly or through consultation with other care professionals. Additionally, palliative care specialists engage in activities beyond the primary care process, such as advocacy, raising social awareness, providing education and bedside teaching, co-authoring palliative care guidelines, and participating in or conducting scientific research. Finally, the participants agreed on the criteria for determining which healthcare professionals can become specialists in palliative care. Conclusion The results of this study can be used to describe a profile of specialized expertise in palliative care, which may contribute to the clarity and quality of the Dutch mixed model of palliative care. We reflect on how and to which extent these results provide input to this profile and what requires attention in developing and implementing this profile in Dutch healthcare.