scholarly journals Determinants of hospital death in haematological cancers: findings from a qualitative study

2017 ◽  
Vol 8 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Dorothy McCaughan ◽  
Eve Roman ◽  
Alexandra G Smith ◽  
Anne Garry ◽  
Miriam Johnson ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Qualitative Interviews ◽  
Population Based ◽  
Poor Quality ◽  
Research Network ◽  
Hospital Death ◽  
Haematological Malignancies ◽  
Home Death ◽  
Hospital Deaths ◽  
Advance Planning

ObjectivesCurrent UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases.MethodsThe study was set within the Haematological Malignancy Research Network (HMRN—www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data.ResultsFive themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred.ConclusionsHospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death.

scholarly journals Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network

2020 ◽  
pp. bmjspcare-2019-002097
Author(s):  
Rebecca Sheridan ◽  
Eve Roman ◽  
Alex G Smith ◽  
Andrew Turner ◽  
Anne C Garry ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Haematological Malignancy ◽  
Care Home ◽  
Healthcare Services ◽  
Population Based ◽  
Place Of Death ◽  
Research Network ◽  
Hospital Death ◽  
The Uk ◽  
Proximity To Death

ObjectivesHospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions.MethodsSet within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004–2012 who died 2011–2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion.ResultsOf 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion.ConclusionChallenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.

scholarly journals Cohort Profile: The Haematological Malignancy Research Network (HMRN): a UK population-based patient cohort

2018 ◽  
Vol 47 (3) ◽  
pp. 700-700g ◽  
Author(s):  
Alexandra Smith ◽  
Debra Howell ◽  
Simon Crouch ◽  
Dan Painter ◽  
John Blase ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Population Based ◽  
Research Network ◽  
Patient Cohort

scholarly journals Cell‐of‐origin in diffuse large B‐cell lymphoma: findings from theUK's population‐based Haematological Malignancy Research Network

2018 ◽  
Vol 185 (4) ◽  
pp. 781-784 ◽  
Author(s):  
Daniel Painter ◽  
Sharon Barrans ◽  
Stuart Lacy ◽  
Alexandra Smith ◽  
Simon Crouch ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Haematological Malignancy ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Research Network ◽  
Cell Of Origin ◽  
Large B Cell Lymphoma ◽  
Large B Cell

scholarly journals Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e039533
Author(s):  
Anna H Balabanski ◽  
Kendall Goldsmith ◽  
Blake Giarola ◽  
David Buxton ◽  
Sally Castle ◽  
...  
Keyword(s):  
Aboriginal People ◽  
Population Based ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Healthcare Facilities ◽  
Aboriginal Population ◽  
Hospital Deaths ◽  
Central Australia

ObjectivesWe aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities.DesignA retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014.SettingAlice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2.Participants161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke.Primary and secondary outcome measuresRates of first-ever stroke, overall (all events) stroke and in-hospital death.ResultsOf 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p<0.001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged <55 years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p<0.001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients.ConclusionsStroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged <55 years.

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