Transitions to palliative care in acute hospitals in England: qualitative study

Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.

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Symptom Assessment for a Palliative Care Approach in People With Dementia Admitted to Acute Hospitals

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988715588835 ◽

2015 ◽

Vol 28 (4) ◽

pp. 255-259 ◽

Cited By ~ 4

Author(s):

Emma O’Shea ◽

Suzanne Timmons ◽

Sean Kennelly ◽

Anna de Siún ◽

Paul Gallagher ◽

...

Keyword(s):

Palliative Care ◽

Symptom Assessment ◽

People With Dementia ◽

Acute Hospitals ◽

Care Approach

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The impact of the environment on patient experiences of hospital admissions in palliative care

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2015-000891 ◽

2015 ◽

Vol 8 (4) ◽

pp. 485-492 ◽

Cited By ~ 6

Author(s):

Jackie Robinson ◽

Merryn Gott ◽

Clare Gardiner ◽

Christine Ingleton

Keyword(s):

Palliative Care ◽

Health Professionals ◽

Hospital Admissions ◽

Hospital Setting ◽

Prognostic Indicators ◽

Care Needs ◽

Acute Hospitals ◽

Almost All ◽

The Impact ◽

Palliative Care Needs

ObjectiveTo explore the impact of environment on experiences of hospitalisation from the perspective of patient's with palliative care needs.MethodsA qualitative study design using longitudinal semistructured, face-to-face interviews were used to elicit the views of patients with palliative care needs admitted to hospital in 1 large urban acute hospital in New Zealand. The sample comprised of 14 patients admitted to hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need.ResultsAlmost all participants described a range of factors associated with the environment which impacted negatively on their experiences of hospitalisation. This included challenges with the physical surroundings, the impact on social relationships with other patients, families and health professionals and the influence of the cultural milieu of the hospital setting.ConclusionsEmulating the ‘ideal’ environment for palliative care such as that provided in a hospice setting is an unrealistic goal for acute hospitals. Paying attention to the things that can be changed, such as enabling family to stay and improving the flexibility of the physical environment while improving the social interplay between patients and health professionals, may be a more realistic approach than replicating the hospice environment in order to reduce the burden of hospitalisations for patients with palliative care needs.

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Palliative Care For Patients with Advanced COPD in Primary Care

Praxis ◽

10.1024/1661-8157/a003790 ◽

2021 ◽

Vol 110 (15) ◽

pp. 902-906

Author(s):

Tanja Fusi-Schmidhauser

Keyword(s):

Primary Care ◽

Palliative Care ◽

Symptom Management ◽

Quality Care ◽

Symptom Burden ◽

High Quality ◽

High Quality Care ◽

Care And Support ◽

Care Approach ◽

Advance Planning

Abstract. Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.

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Enabling Advance Care Planning in Dementia Care: A Primary Care Approach

Journal of Palliative Care ◽

10.1177/0825859720973937 ◽

2020 ◽

pp. 082585972097393

Author(s):

Linda Lee ◽

Loretta M. Hillier ◽

Stephanie K. Lu ◽

Donna Ward

Keyword(s):

Primary Care ◽

Advance Care Planning ◽

Health Professionals ◽

Online Survey ◽

Ease Of Use ◽

Depth Information ◽

Care Planning ◽

Care Approach ◽

Memory Clinics ◽

Advance Care

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions. Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework. Methods: We used a mixed methods approach. Health professionals completed an online survey following pilot testing and PLWD and substitute decision makers (SDM) completed survey immediately following the ACP discussion assessing their satisfaction (5-point scale) with the framework and exploring potential outcomes. Interviews with health professionals, PLWD, and SDM were conducted to gather more in-depth information on their perceptions of the ACP framework/ discussion. Results: Surveys were completed by 12 health professionals, 13 PLWD, and 16 SDM. While PLWD and SDM were satisfied with the ACP discussion (M = 4.0/5), health professionals were minimally satisfied with the ease of use of the framework (M = 2.0/5), acceptability for patients (M = 2.4/5) and feasibility in practice (M = 1.9/5). Sixteen interviews were completed with 8 health professionals, 1 PLWD, and 7 SDM. While health professionals valued ACP, lack of time and training were identified barriers to framework use. SDM felt better prepared for future decisions and PLWD were put at ease, knowing that their wishes for care were understood. Conclusion: PLWD and SDM value the opportunity for ACP, and although health professionals identified some concerns with framework administration, they acknowledge the value and importance of ACP. Continuing efforts to refine ACP processes are justified.

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Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

BMJ Open ◽

10.1136/bmjopen-2021-053222 ◽

2022 ◽

Vol 12 (1) ◽

pp. e053222

Author(s):

Manbinder Sidhu ◽

Jack Pollard ◽

Jon Sussex

Keyword(s):

Primary Care ◽

Vertical Integration ◽

Secondary Care ◽

Primary Care Providers ◽

Health Economy ◽

Service Utilisation ◽

England And Wales ◽

Acute Hospitals ◽

Care Practices ◽

Primary Care Practices

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

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What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

British Journal of General Practice ◽

10.3399/bjgp19x703505 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703505

Author(s):

Joseph Clark ◽

Elvis Amoakwa ◽

John Blenkinsopp ◽

Florence Reedy ◽

Miriam Johnson

Keyword(s):

Primary Care ◽

Palliative Care ◽

Qualitative Study ◽

Focus Groups ◽

Cancer Care ◽

Information Needs ◽

Controlled Trial ◽

Unmet Need ◽

Care Staff ◽

Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

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Using information and communication technologies to improve the management of pain from advanced cancer in the community: Qualitative study of the experience of implementation for patients and health professionals in a trial

Health Informatics Journal ◽

10.1177/1460458220906289 ◽

2020 ◽

Vol 26 (4) ◽

pp. 2435-2445

Author(s):

Julia Hackett ◽

Matthew J Allsop ◽

Sally Taylor ◽

Michael I Bennett ◽

Bridgette M Bewick

Keyword(s):

Palliative Care ◽

Pain Management ◽

Qualitative Study ◽

Information And Communication Technology ◽

Communication Technology ◽

Health Professionals ◽

Randomised Control Trial ◽

Care Practice ◽

Technology System ◽

Information And Communication

In cancer care, there are emerging information and communication technology systems being developed, enabling real-time information sharing between patients and health professionals. This study explored health professionals’ and patients’ perceptions of their engagement with an information and communication technology system for pain management to understand the mechanisms that could support implementation into routine palliative care practice. This was a qualitative study, embedded within a randomised control trial, using semi-structured face-to-face interviews. Data were analysed using thematic analysis. The role of health professionals was a key component to patient engagement with the information and communication technology system. Where patients engaged with the information and communication technology system, both patients and health professionals reported benefits to system use in addition to usual care. Implementation issues were identified that can be used to guide future system development to support pain management in the context of routine clinical care in palliative care services. Where interventions are dependent on multiple providers, collaborative working and consideration of the context within which they are set are needed.

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Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care

BMJ Open ◽

10.1136/bmjopen-2017-020521 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020521 ◽

Cited By ~ 5

Author(s):

Anne-Marie Burn ◽

Jane Fleming ◽

Carol Brayne ◽

Chris Fox ◽

Frances Bunn

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Secondary Care ◽

Healthcare Professionals ◽

Hospital Staff ◽

Case Finding ◽

Care Staff ◽

Dementia Case ◽

Primary Care Staff ◽

Views Of Healthcare Professionals

ObjectivesIn 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.DesignQualitative study involving interviews, focus groups and thematic content analysis.SettingPrimary care and secondary care across six counties in the East of England.ParticipantsHospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.ResultsWe recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.ConclusionsThe study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.

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