Background: An appreciation of the broader social determinants of health and wellbeing has led to the inclusion of new public health principles and practice within health and social care. End-of-life care has been no exception and there exists a favourable policy context, significant body of theoretical work, substantial practitioner interest and numerous practice examples. Despite this context, there has been little empirical exploration and the approaches remain poorly characterised. Aims and objectives: The aim of this study was to understand the impact a new public health approach to end-of-life care project can have when initiated through a hospice. Specifically this study sought to explore how a compassionate community project is experienced, what tensions exist, what processes support or impede the work, what specific challenges such a project developed from within this sector presents and what learning exists for the wider field. Methods: A mixed methods study employing multiple methods of data collection was performed. Data collection methods included: interviews; focus groups; participant observation; documentary analysis and service records. Ethics approval was obtained. Data were analysed according to modified grounded theory and using online software tool Dedoose. Results: Twenty-one interviews, two focus groups and 19 episodes of participant observation were conducted, 11 documents and service data on 180 Compassionate Neighbours and 173 Community Members were also included. Six key actions facilitated integration of new public health approaches with service provision approaches. Impacts from the work were wide ranging and included a reduction in loneliness, improvements in wellbeing and changes to hospice practice. Further to this, three underlying drivers emerged that underpinned the work as a whole. They were seen to translate the observed actions of the project into the impacts and included: altered power dynamics, expression of reciprocity in relationships and the development of agency. Discussion: The three drivers allow a deeper appreciation of the factors involved in the development of a compassionate community. The redressing of power dynamics within traditional provider-recipient relationships allowed for more equity, and created a space for reciprocal and mutual relations to emerge. Not only were these reciprocal relations observed between those at the end of life and those visiting them, but also between participants in the project and the hospice. In order to adequately capture these new perspectives offered through this study, a new term collective social capital is introduced. This moves beyond existing conceptualisations of social capital in end-of-life care to provide novel perspectives on the role of reciprocity and interdependency between the lay and professional worlds. Conclusion: This study provides a reflexive and critical account of the processes and impacts of compassionate communities work in practice. It situates reciprocal relationships as its foundation and forces an assessment of the nature of power and agency in all interactions. Through the presentation of the new concept of collective social capital, it presents a collaborative and interdependent path forward for new public health and end-of-life care in the future.

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<p><strong>Introduction</strong></p> <p>Despite increasing global interest in regional palliative care networks (PCN) to integrate care, little explicit direction exists to guide their evaluation. The first step of this research was to develop a comprehensive conceptual framework using a systems approach for evaluating integrated palliative care. This framework was then used to guide a rigorous examination of a selected PCN.</p> <p><strong>Methods</strong></p> <p>The conceptual framework was derived from the empirical literature, incorporating principal features of network integration. A case study methodology was used to assess structure (administration) and process (provider) levels in the framework through document review, a PCN executive interview, and surveys with organizational administrators and health professionals who provide palliative care in the community catchment of the PCN.</p> <p><strong>Results</strong></p> <p>Key features to efficient palliative care delivery are currently lacking across this PCN area. Still, the 20 responding administrators (90% response rate) largely viewed Network accomplishments positively and the resulting partnerships as beneficial and collaborative. Additional efforts were seen as required in ensuring palliative care patient identification, reducing silos between organizations, and greater by-in from regional authorities. Relative to processes, the 86 health care providers (85% response rate) reported valuing collaboration and reflected positively on many of the framework elements measured. Insufficiencies were perceived in support for case conferencing and evaluative activities, as well as in informational access.</p> <p><strong> </strong></p> <p><strong>Conclusion</strong></p> <p>This study enabled us to test both the utility of the framework and the capacity of the selected PCN for providing quality, integrated palliative care. This study represents an important initial attempt at examining network-integrated palliative care.</p> / Doctor of Philosophy (PhD)