Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients

Beernaert, Kim; Deliens, Luc; Vleminck, Aline De; Devroey, Dirk; Pardon, Koen; Block, Lieve Van den; Cohen, Joachim

doi:10.1177/0269216314522318

Cited by 70 publications

(138 citation statements)

References 32 publications

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“…Furthermore the relief experienced by families when the hospital admission finally occurred indicated a level of anxiety for caregivers. Worsening and unexplained symptoms and anxiety (30), indeed one study has described as Anxieties about remaining at home when problems, such as unbearable pain, occur can leave patients feeling frightened and insecure (31).…”

Section: Discussionmentioning

confidence: 99%

“…This suggests there is something unique about being in hospital that might be difficult to replicate in the home setting. A recent study by Beernaert et al (31) explored barriers and facilitators to the early identification by general practitioners of palliative care needs. They found that patients often viewed their hospital physicians as being more capable than their general practitioner when dealing with specific manifestations of their illnessThe authors found that general practitioners are less likely to be involved when patient are receiving curative or life prolonging treatment and find it easier to identify palliative care needs in the last weeks of life when prognosis is clearer (31).…”

Section: Discussionmentioning

confidence: 99%

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A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs

et al. 2015

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Background: The acute hospital plays a significant role in caring for people with a life-limiting illness. Most research to date has focused exclusively upon the negative aspects of hospitalisation. Currently, there is little known about the benefits of hospital admissions for patients with palliative care needs. Aim: The aim of this study was to explore the benefits of hospital admissions, from the perspectives of patients with palliative care needs. Design: A qualitative study design was adopted. Longitudinal, semi-structured, face-to-face interviews were used to elicit the views of patients admitted to hospital in one large urban acute hospital in New Zealand. Setting/participants: The study sample comprised 14 patients admitted to Auckland City Hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need. Results: Through a process of thematic analysis, four themes were identified from the data: being cared for and feeling safe, receiving care to manage at home, relief for family and ‘feeling better and/or getting better’. The benefits of being in hospital were reported to extend beyond treatments received. Most participants reported their preference was to come to hospital even if they had been able to access the care they received in hospital at home. Conclusion: This research contributes to a greater understanding of the benefits associated with hospitalisation for patients with palliative care needs. The findings suggest that such benefits extend beyond the treatment patients receive and challenge current assumptions regarding the role of the acute hospital in palliative care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs

et al. 2015

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“…Furthermore, feeling incompetent to deal with dying patients might prevent family physicians from taking responsibility for keeping the patient at home or to being available to them. That family physicians are more familiar with cancer end-of-life trajectories 43,44 might also partially explain why cancer patients are more likely to die at home or less likely to die in hospital, compared with patients dying of other causes. 3,4,14,45,46 Improving competencies and attitudes through adequate end-of-life care training therefore seems to be essential to reducing the number of end-of-life hospital admissions.…”

Section: Discussionmentioning

confidence: 99%

The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

Reyniers

Houttekier

Pasman³

et al. 2014

The Annals of Family Medicine

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PURPOSE Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life.METHODS Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach.RESULTS Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. CONCLUSIONS Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life.

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“…Thirdly, awareness and acceptance of palliative care as an emancipated, helpful discipline in lung cancer beyond end-of-life care may be lacking in patients, caregivers and professionals [135][136][137]. WARD et al [138] entitled their survey study "Collaborating or co-existing", highlighting appreciation and barriers in medical oncologists towards palliative care services.…”

Section: Barriers For Integration Of Palliative Care Into Routine Lunmentioning

confidence: 99%

The lung cancer patient, the pneumologist and palliative care: a developing alliance

Blum

Schönfeld

2014

Eur Respir J

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Considerable evidence is now available on the value of palliative care for lung cancer patients in all stages and at all times during the course of the disease. However, pneumologists and their institutions seem to be widely in arrears with the implementation of palliative care concepts and the development of integrated structures.This review focuses on the available evidence and experience of various frequently unmet needs of lung cancer patients, especially psychological, social, spiritual and cultural ones. A PubMed search for evidence on these aspects of palliative care as well as on barriers to the implementation, on outcome parameters and effectiveness, and on structure and process quality was performed with a special focus on lung cancer patients.As a consequence, this review particularly draws pneumologists' attention to improving their skills in communication with the patients, their relatives and among themselves, and to establish team structures with more far-reaching competences and continuity than existing multilateral cooperations and conferences can provide. Ideally, any process of structural and procedural improvement should be accompanied by scientific evaluation and measures for quality optimisation. @ERSpublications Pneumologists should get more widely involved in palliative care for lung cancer patients

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Early identification of palliative care needs by family physicians: A qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients

Cited by 70 publications

References 32 publications

A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs

A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs

The Family Physician's Perceived Role in Preventing and Guiding Hospital Admissions at the End of Life: A Focus Group Study

The lung cancer patient, the pneumologist and palliative care: a developing alliance

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