Background: Social 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.
Aim: To 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.
Design: A 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 Bronfenbrenner’s ecological theory was used to inform the analysis.
Setting/Participants: 133 participants, were recruited from three economically and culturally different geographic areas within England.
Results: Although 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.
Conclusion: The 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?
Homecare workers provide a crucial service to people receiving care at end-of-life and wishing to remain in their own homes
Collaborative working between social and healthcare services improves care provision.
What this paper adds
Barriers 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.
Healthcare practitioners often had poor knowledge of and undervalued the homecare worker role, exacerbating poor communication and collaboration.
Examples of good practice and potential solutions to barriers to interprofessional working
Implications for practice, theory or policy
Healthcare practitioners require training to better understand, recognise and appreciate the role of homecare workers
Communication barriers should be addressed to enable the homecare worker to contribute effectively to the multi-disciplinary team.
The homecare workforce’s role in providing high quality end-of-life care will remain constrained without wider professional and societal acknowledgement of its value.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Protocols
https://doi.org/10.1371/journal.pone.0298925
Funding Statement
This study/project was funded by the NIHR HSDR Programme (project reference NIHR 135128). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)