“Going Home [Is] Just a Feel-Good Idea With No Structure”: A Qualitative Exploration of Patient and Family Caregiver Needs When Transitioning From Hospital to Home in Palliative Care
“…Qualitative data. The initial codes were developed inductively through grounded theory approach (see Isenberg et al, 31 for more details). Transcripts were analyzed and coded throughout the interview process by a Item count: 20 direct questions were in the interview guide, however probing questions were asked to clarify and obtain deeper insights into answers Score range: NA Interpretation: NA Dichotomy calculation: Transcript 1 was designated high readiness for discharge when the codes mapped to the RHDS were discussed in a positive light, or they had a positive experience not captured in the RHDS codes; they were designated low readiness when the codes mapped to the RHDS were negatively discussed, or they had a negative experience not captured in the RHDS codes Transcript 2 was designated high quality when the codes mapped to the CTM-3 were discussed in a positive light, or they had a positive experience not captured in the CTM-3 codes; they were designated low quality when the codes mapped to the CMT-3 were negatively discussed, or they had a negative experience not captured in the CTM-3 codes Transcript 3 was designated high coping-difficulty when the codes mapped to the PDCDS were discussed in a positive light, or they had a positive experience not captured in the PDCDS codes; they were designated low coping-difficulty when the codes mapped to the PDCDS were negatively discussed, or they had a negative experience not captured in the PDCDS codes NA; not applicable.…”
Section: Discussionmentioning
confidence: 99%
“…The initial codes were developed inductively through grounded theory approach (see Isenberg et al, 31 for more details). Transcripts were analyzed and coded throughout the interview process by a minimum of two reviewers (SS, SRI, TK) using MaxQDA data analysis software; 32 disagreement was resolved through discussion.…”
Background: Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care. Aim: Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions. Design: Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data. Setting and participants: Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients ( n = 25) and their caregivers ( n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care. Results: Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress. Conclusions: We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.
“…Qualitative data. The initial codes were developed inductively through grounded theory approach (see Isenberg et al, 31 for more details). Transcripts were analyzed and coded throughout the interview process by a Item count: 20 direct questions were in the interview guide, however probing questions were asked to clarify and obtain deeper insights into answers Score range: NA Interpretation: NA Dichotomy calculation: Transcript 1 was designated high readiness for discharge when the codes mapped to the RHDS were discussed in a positive light, or they had a positive experience not captured in the RHDS codes; they were designated low readiness when the codes mapped to the RHDS were negatively discussed, or they had a negative experience not captured in the RHDS codes Transcript 2 was designated high quality when the codes mapped to the CTM-3 were discussed in a positive light, or they had a positive experience not captured in the CTM-3 codes; they were designated low quality when the codes mapped to the CMT-3 were negatively discussed, or they had a negative experience not captured in the CTM-3 codes Transcript 3 was designated high coping-difficulty when the codes mapped to the PDCDS were discussed in a positive light, or they had a positive experience not captured in the PDCDS codes; they were designated low coping-difficulty when the codes mapped to the PDCDS were negatively discussed, or they had a negative experience not captured in the PDCDS codes NA; not applicable.…”
Section: Discussionmentioning
confidence: 99%
“…The initial codes were developed inductively through grounded theory approach (see Isenberg et al, 31 for more details). Transcripts were analyzed and coded throughout the interview process by a minimum of two reviewers (SS, SRI, TK) using MaxQDA data analysis software; 32 disagreement was resolved through discussion.…”
Background: Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care. Aim: Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions. Design: Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data. Setting and participants: Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients ( n = 25) and their caregivers ( n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care. Results: Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress. Conclusions: We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.
“… 18 With rapidly increasing demand for care due to aging, society is confronted with the problems of who should, where and how to, implement it ( Figure 1 ). 19 Figure 1 Conceptual chart of community care promotion. …”
Section: Theoretical Backgroundmentioning
confidence: 99%
“…18 With rapidly increasing demand for care due to aging, society is confronted with the problems of who should, where and how to, implement it (Figure 1). 19 The 2018 elderly situation survey conducted by the Ministry of Health and Welfare on older adults in Seoul suggested that they prefer to remain in their own residence, even if it is uncomfortable. 20 However, despite the advent of the aging society and the diversification of needs, society has limitations in fulfilling universal care needs, with in-home care services only accessible to vulnerable social groups.…”
Purpose
This study utilized text mining to analyze research trends around community care, which focuses on improving patients’ quality of life by lessening the financial burden on caregivers and relieving patient discomfort.
Methods
To examine research trends by community care stage, Section 1 is set from 2017 to 2019, when the community care was implemented, and Section 2 from 2020 to 2021, after the end of the community care. Papers used for the analysis were extracted using the Korea Citation Index (KCI); a total of 132 articles were selected and subjected to text mining analysis.
Results
First, the main community care research areas included work, housing, economy, disability, and mind. Second, from 2017 to 2019, there was considerable interest in community care centered on households, and main keywords, such as nursing, family, and experience, appeared. Third, from 2020 to the present, there was high interest in community care centered on disabilities, and keywords, such as space, business, and Seoul City, appeared.
Conclusion
The results reveal the changing issues, with the implementation of community care. Overall, research has tended to focus on social and welfare systems, rather than health and medical systems. In the future, local, community-integrated health and medical care systems should be restructured and regional delivery systems established to make them more accessible.
“…Older adults are at a significant risk during the discharge process from hospital (Li et al, 2014). The discharge process can be challenging for health care providers, older adults, and their family caregivers (Drew et al, 2016; Isenberg et al, 2021). It is further complicated by the complexities of the health system because care and services are delivered by multiple health care providers with various levels of accountability (Salehi, Hanson, et al, 2021).…”
This study aims to introduce an innovative method to schedule and analyze the discharge planning processes under uncertain individual activity completing times. Hospital care processes ending in discharging older adults represent a major challenge, as a number of interrelated tasks or activities are involved in the processes. The functional resonance analysis method (FRAM) is used to identify activities that constitute a descriptive model of the discharge planning processes and to assign the completion time to each task or activity. Then the critical path planning technique is utilized to identify the critical path of the discharge process. To this end, the Program Evaluation and Review Technique (PERT) is employed. Published data regarding six older patients are used to examine the potential utility of the introduced method to improve the discharge process of older adults. The results show that the integration of the FRAM and PERT is able to identify the critical activities that constitute the critical path of the discharge process. It also helps analyze the completion time assigned to each task/activity and calculate the completion time of the discharge process. The probability of completing the discharge process within a target completion time is also discussed. The results add further evidence showing the applicability of the FRAM and PERT to scheduling systems for the discharge planning processes. Health care professionals could use the findings of this study in designing a scheduling system to complete the discharge process of older adults in a reasonable time.
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