Identifying Factors Significant to Continuity in Basic Palliative Hospital Care—From the Perspective of Patients with Advanced Cancer

Abstract

Based on the research method grounded theory and semistructured patient interviews at home following hospitalization, the aim was to provide information on issues relating to the identification and alleviation of patients' physical and emotional problems, understood as continuity in palliative care. The interviews were based on selected problems that patients found significant. The results are distilled into the core category disheartening interactions and four categories: falling outside the professional framework, not being seen as a person, unidentified/unmet need for guidance and involvement, and patient strategy-minimizing conflict. The categories are significant in generating and maintaining continuity in basic palliative care.

Patients’ experiences and perspectives of multiple concurrent symptoms in advanced cancer: a semi-structured interview study

“…Reviews of specialist PC have also highlighted a lack of training on communication skills at the end of life and standardised referral to PC [36][37][38]. Our results support the need for PC to be fully integrated 'upstream' within the mainstream curative healthcare system and the imperative for HPs to connect on a 'human level' with PC patients [39,40].…”

Unmet care needs in people living with advanced cancer: a systematic review

“…Assuming patients are able and willing to direct their care (as 'health consumers') problem-need dissociations may be taken to reflect a patient's wishes to prioritise other areas or preference to draw on alternative sources of support in that domain -and we found evidence that patients can explicitly identify problems that they do not wish to receive professional help with [31]. However, dissociations could also reflect a lack of awareness regarding available supports (e.g., misperception that some domains may be outside the remit of care providers) or minimisation of difficulties and self-subjugation (e.g., [34]). …”

“…Of the 13 studies that applied a multidimensional approach (11 quantitative [3, 19-22, 26, 27, 31, 32, 37] and 2 qualitative [23,34]) all identified unmet needs in the domain of psychological experience (n = 13), and most identified needs in informational (n = 11), physical (n = 11), and functional (n = 11) domains.…”

How continuity of care is experienced within the context of integrated palliative care: A qualitative study with patients and family caregivers in five European countries

“…8,9 However, continuity of care is often at stake in care provision for patients with advanced diseases who usually receive care from multiple health care professionals. [9][10][11][12][13] Lack of continuity of care can cause undesired experiences with palliative care provision, for example, feeling unsafe during illness transitions, 9 patients being transferred between multidisciplinary teams 11 and suboptimal support for problems and needs. 12,13 Integrated palliative care has been increasingly proposed in order to achieve continuity of care for patients with advanced diseases.…”