Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life

Abstract

Background A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. Methods A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. Results Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals’ roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. Discussion This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.

The Palliative Care Illusion on Acute Wards An Ethnographic Study of the Introduction of a Palliative Care Consultation Team

“…Interestingly, some primary team members had their own name for PC, so-called restricted or limited care, a kind of "PC light", and restricted the term PC to care in the last hour of life. The latter has also been reported in another study 42 where physicians, even after training, continued to associate PC with the terminal or dying stage. This shows how di cult (but not impossible) it can be to change the everyday thinking and routines of a culture.…”

More older adults died at their preferred place after implementation of a transmural care pathway for older adults at the end of life: a before-after study

“…At least one of the patients’ own primary healthcare professionals attended more meetings during/shortly after implementation, but not on the long term. This could be caused by practical issues such as travel time [ 13 ], and the COVID-19 pandemic which could have made it less likely to visit other healthcare organizations. Moreover, the division between primary and secondary care, and perceptions on were palliative care should be provided [ 21 ] probably influenced the involvement of primary care professionals, especially GPs.…”

“…We collected data from first-time palliative care team consultations held between February 2017 and February 2020 in an urban teaching hospital in Amsterdam with 633 beds. In this hospital, the PalliSupport intervention, comprising an educational programme and transmural palliative care pathway was implemented and the pilot study [ 13 ] took place (Table 1 ).…”

“…To improve collaboration between hospitals and primary care organizations in the palliative care of acutely admitted older patients, the PalliSupport transmural palliative care pathway (hereafter referred to as pathway) was developed [ 13 ]. The pathway was developed based on research on the identification of palliative care needs and current collaboration [ 14 – 16 ], best practices, and in collaboration with experts in the field.…”

“…A pilot study was carried out including patients recruited during the initial 6 months in which the PalliSupport pathway was introduced (Table 1 ). In this study we found that adjustments were needed to incorporate a more active recruitment approach, additional training on identification and palliative care, further improvement on data collection and more involvement of general practitioners (GP) [ 13 ]. The PalliSupport pathway was continued as part of routine clinical care after the pilot study was completed.…”