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Question: The Kerala Project NNPC is basically run by volunteers, and professionals in Palliative Care provide interventions only if called by the network. In three different settings in Eastern Switzerland/ Liechtenstein (urban, rural, mixed) an explorative study showed a variety of different services that offer support at home for severely ill patients and their families, but a lack of collaboration and coordination among these services have been stated. In addition, volunteer support is rarely integrated in home care.
Methods: potential barriers for collaboration and exchange and integration of volunteers were analysed during semistructured interviews as well as through the “world cafe- method” during regional round tables calling together the different support organisations.
Results: There were several barriers detected which may not exist in Kerala but in Eastern Switzerland:
(a) Death and dying occurs in the homecare setting in less than 20% and experience of caring for the dying is lacking,
(b) the population expects professional health care at the end of life, and volunteers may not be accepted as being helpful,
(c) among different support organisations competition and a lack knowledge of each others competences undermine effective coordination and collaboration,
(d) the majority of volunteers self limit their activities to bedside care only,
(e) there is no commonly accessable documeantation system,
(f) there no coordinating person (volunteer or professional).
Conclusions: A highly professionalised health care system, low rates of home deaths and deficits in communication and collaboration among regional support teams are major barriers for effective community Palliative Care compared to Kerala. Overmedicalisation of the end of life is often criticized in our country but the delivery of “humanistic” care and support through non-professionals/ volunteers seem to be rarely accepted and has no tradition in our country.