Transitions to palliative care for older people in acute hospitals: a mixed-methods study
Background: Improving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last...
Main Authors: | , , , , , , , , , , |
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Format: | Article |
Language: | English |
Published: |
NIHR Journals Library
2013-11-01
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Series: | Health Services and Delivery Research |
Online Access: | https://doi.org/10.3310/hsdr01110 |
Summary: | Background: Improving the provision of palliative and end-of-life care is a priority for
the NHS. Ensuring an appropriately managed ‘transition’ to a
palliative approach for care when patients are likely to be entering the
last year of life is central to current policy. Acute hospitals represent a
significant site of palliative care delivery and specific guidance has been
published regarding the management of palliative care transitions within
this setting. Aims: (1) to explore how transitions to a palliative care approach are managed and
experienced in acute hospitals and to identify best practice from the
perspective of clinicians and service users; (2) to examine the extent of
potentially avoidable hospital admissions amongst hospital inpatients with
palliative care needs. Design: A mixed-methods design was adopted in two hospitals in England, serving
diverse patient populations. Methods included (1) two systematic reviews;
(2) focus groups and interviews with 58 health-care professionals to explore
barriers to, and facilitators of, palliative care transitions in hospital;
(3) a hospital inpatient survey examining palliative care needs and aspects
of management including a self-/proxy-completed questionnaire, a survey of
medical and nursing staff and a case note review; (4) in-depth interviews
with 15 patients with palliative care needs; (5) a retrospective case note
review of all inpatients present in the hospital at the time of the survey
who had died within the subsequent 12 months; and (6) focus groups with 83
key decision-makers to explore the implications of the findings for service
delivery and policy. Results: Of the 514 patients in the inpatient survey sample, just over one-third
(n = 185, 36.0%) met one or more of the
Gold Standards Framework (GSF) prognostic indicator criteria for palliative
care needs. The most common GSF prognostic indicator was frailty, with
almost one-third of patients (27%) meeting this criteria. Agreement between
medical and nursing staff and the GSF with respect to identifying patients
with palliative care needs was poor. In focus groups, health professionals
reported difficulties in recognising that a patient had entered the last 12
months of life. In-depth interviews with patients found that many of those
interviewed were unaware of their prognosis and showed little insight into
what they could expect from the trajectory of their disease. The
retrospective case note review found that 35 (7.2%) admissions were
potentially avoidable. The potential annual cost saving across both
hospitals of preventing these admissions was approximately £5.3M.
However, a 2- or 3-day reduction in length of stay for these admissions
would result in an annual cost saving of £21.6M or £32.4M
respectively. Conclusions: Patients with palliative care needs represent a significant proportion of the
hospital inpatient population. There is a significant gap between NHS policy
regarding palliative and end-of-life care management in acute hospitals in
England and current practice. Funding: The National Institute for Health Research Health Services and Delivery
Research programme. |
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ISSN: | 2050-4349 2050-4357 |