Hospital-Based Mobile Units: Assuring High Quality Palliative Care Through Close Collaboration Between Mobile Teams in Hospitals, Hospices, Home Care Providers, Primary Care Providers, Patients and Families

Key Contextual Factors

• In the past, palliative care for patients was insufficient, with examples being a lack of structured pain management and support for families.
• Some key moments for palliative care in Luxembourg were: the creation of the association OMEGA 90 in 1990, the law on palliative car in 2009 and the development of a national palliative care plan with a national committee for palliative care under the responsibility of the Ministry of Health in 2019.
• The responsible entities for palliative care in Luxembourg are: the Ministry of Health for hospital structures; the Ministry of Family for home care, institutions for elderly; the Ministry of Social Security for financing.
• Additionally, there are couple of concerned associations and coordinating entities:
• The target group is all patients in need of palliative care including oncology patients. Families of the patients in need are also being supported.

Key Components/Steps

• The first hospital-based multidisciplinary mobile units were formed in 2000 to work across all hospital units.
• Cooperation and regular communication between hospital palliative teams, home care organisations, hospices, primary care provider, patients and their families have been established.
• An assessment of the feasibility of home care for palliative patients, based on the Delphi technique to reach consensus, was introduced under the responsibility of the association OMEGA 90.
• A Luxemburgish regulation was passed in February 2019 that made basic palliative training for doctors and other healthcare professionals obligatory.
• A multidisciplinary end-of-life working group was established in 2019 to address the topics related to palliative care at the national level.

Main Impacts / Added Value

• Patients receive access to high-quality palliative care in the setting which is most suitable for their specific needs and in accordance with their personal advanced care plan. This can be at home, hospice or hospital.
• Enhanced communication between patients, their families and various healthcare services permits the identification of best possible solution for each individual patient.
• Patients have comfort in knowing that they are being cared for by a team of specialists (e.g., palliative care physicians, specialised nurses, carers and psychologists).

Lessons Learned

• Importance of collaboration beyond the organisational borders of hospitals (i.e., with primary care providers, home care providers, hospices).
• Importance of involving the patient and their family in the decision of the care setting.
• Necessity of a legal framework for specialised palliative care training.
• Areas for further improvement (e.g., increasing scope of home visits by palliative specialists to include night-time).

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