The funding of specialised paediatric palliative care in Switzerland: a conceptualisation and modified Delphi study on obstacles and priorities
Delphi study; funding; modified Delphi study; palliative therapy; pediatrics; Switzerland; adult; aged; article; clinical practice; consensus development; Delphi Technique; evidence based medicine; female; health care cost; health care delivery; health service; human; male; Palliative Care; practice guideline; program effectiveness; program sustainability; reimbursement; Switzerland
BACKGROUND: Effective funding models are key for implementing and sustaining critical care delivery programmes such as specialised paediatric palliative care (SPPC). In Switzerland, funding concerns have frequently been raised as primary barriers to providing SPPC in dedicated settings. However, systematic evidence on existing models of funding as well as primary challenges faced by stakeholders remains scarce. AIMS: The present study’s first aim was to investigate and conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. Its second aim was to identify obstacles to and priorities for funding these programmes sustainably. METHODS: A 4-step process, including a document analysis, was used to conceptualise the funding of hospital-based consultative SPPC programmes in Switzerland. In consultation with a purposefully selected panel of experts in the subject, a 3-round modified Delphi study was conducted to identify funding-relevant obstacles and priorities regarding SPPC. RESULTS: Current funding of hospital-based consultative specialised paediatric palliative care programmes is complex and fragmented, combining funding from public, private and charitable sources. Overall, 21 experts participated in the first round of the modified Delphi study, 19 in round two and 15 in round three. They identified 23 obstacles and 29 priorities. Consensus (>70%) was obtained for 12 obstacles and 22 priorities. The highest level of consensus (>90%) was achieved for three priorities: the development of financing solutions to ensure long-term funding of SPPC programmes; the provision of funding and support for integrated palliative care; and sufficient reimbursement of inpatient service costs in the context of high-deficit palliative care patients. CONCLUSION: Decision- and policy-makers hoping to further develop and expand SPPC in Switzerland should be aware that current funding models are highly complex and that SPPC funding is impeded by many obstacles. Considering the steadily rising prevalence of children with life-limiting conditions and the proven benefits of SPPC, improvements in funding models are urgently needed to ensure that the needs of this highly vulnerable population are adequately met.
Mitterer S; Zimmermanna K; Fink G; Simon M; Gerber AK; Bergstrasser E
Swiss Medical Weekly
2023
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.57187/s.3498" target="_blank" rel="noreferrer noopener">10.57187/s.3498</a>
Wrapped with love-art therapy in paediatric palliative care
human; child; expectation; female; male; palliative therapy; comfort; controlled study; conference abstract; narrative; human experiment; art therapy; extended family; grandchild; grandparent; program effectiveness; rest
Introduction To discuss the extended family support that is required in children's palliative care, focusing on Grandparents, who sometimes may be seen as the 'forgotten mourners'. Objectives Utilizing art psychotherapy in a group setting to encourage peer support between ten grandparents (bereaved and non-bereaved) within our inaugural weekend Camp program. Methods Detailing one art therapy session the first morning of the Camp where each of the group chose a pebble to represent their grandchild. They were then invited to choose a different layer, from an extensive array of art materials, to represent each of the important people that wrap, swaddle, comfort, protect, support, and surround this child. There was time dedicated to share their experience and/or artwork within the confidential safe space of the group. This allowed them to express some of the difficulties of having a grandchild with a life limiting illness and the dynamics within the extended family. Results Anonymous pre-and post-narrative evaluations were used to assess expectations prior to the Grandparents weekend and the effectiveness of the program. Discussions within the group at the end of the session and throughout the rest of the weekend revealed that although it had been hard for some to open up, and at times emotional, it was therapeutic and helped form strong bonds within the grandparents. Conclusions It was a useful tool to share internally with the multi-disciplinary team, with added insight utilizing this creative medium. Would possibly like to evaluate more specifically the art therapy component of the program in future camps.
King J
Supportive Care in Cancer
2018
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s00520-018-4193-2" target="_blank" rel="noreferrer noopener">10.1007/s00520-018-4193-2</a>