Skip to main content

Table 1 Description of the threefold consultation service

From: Evaluating the perceived added value of a threefold intervention to improve palliative care for persons experiencing homelessness: a mixed-method study among social service and palliative care professionals

Elements of the threefold consultation service

The intervention comprised three facets. These were: [1] regular reciprocal bedside consultations between social service professionals and palliative care professionals (seeing the patient and talking with them) concerning patients experiencing homelessness who are eligible for palliative care. Involved are professionals working in the field of social services for this population, and palliative care professionals working, for instance, in hospices and General Practices [2]; multidisciplinary meetings between social service professionals and palliative care professionals to discuss patients eligible for palliative care; and [3] training and education on both palliative care and homelessness, whereby the frequency and content were determined by the professionals concerned. Also ‘strategic partnerships’ were created with one consultant in palliative care and one consultant in services for the homeless. This pair of consultants formed the basis for the intervention; the consultants initiated the consultations, multidisciplinary meetings, training sessions, and the involvement of other organizations. Group meetings with all the consultants were scheduled every six months in each region. Social service facilities who participated in the intervention applied a recovery-approach, implicating that social service professionals stimulate and assist residents as much as possible to become as independent as possible. Within this recovery-approach, patient-centered care is a core element, focusing on the needs and wishes of the client.

Intervention duration

The implementation of the threefold consultation service and process evaluation started with a preparatory phase for all three regions from June to September 2019. Implementation plans were made, followed by an execution phase lasting 18 months. From March 2020, the COVID pandemic affected the evaluation. Professionals had less time and had additional tasks, while visiting restrictions meant interviews had to be conducted by phone or video call.

Context-sensitive approach and implementation plans

This intervention was designed to be context-sensitive in order to fit local needs and tie in with existing collaboration efforts and/or further develop them. The regions of Amsterdam, Rotterdam, and Utrecht (three large cities in the Netherlands) participated in this intervention. Part of the context-sensitive design involved working out strategies drawn up in implementation plans by the participating organizations in each of the three regions. These implementation plans covered: the details of organizing the consultations, existing initiatives for consultation, collaboration, knowledge exchange, training, the organization of multidisciplinary meetings and potential for improvement, the organization of training and additional educational requirements, barriers and facilitators for all three elements, characteristics specific to each region, and possibilities for future financing and the continuation and embedding of the intervention. The implementation plans were updated every six months on the initiative of the researchers.

Small-scale intervention

The intervention aimed to start on a small scale and to expand further amongst professionals in the region once the consultations, multidisciplinary meetings, and training were well established.