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

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 of Pictor- 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 provisions 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.