Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review

Abstract

ObjectiveTo identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature.DesignA mixed methods rapid review.MethodsPUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned.OutcomesThe impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions.Results18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity.ConclusionsThis rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.

Rapid review of decision-making for place of care and death in older people: lessons for COVID-19

“…Two papers looked at hospice as a setting [ 11 , 18 ] and four at nursing homes [ 11 , 13 , 16 , 19 ]. There were differences in diagnoses included with seven papers looking specifically at patients with cancer [ 11–13 , 15 , 17–19 ], six including non-cancer diagnoses [ 11–13 , 15 , 18 , 19 ] and two looking specifically at dementia [ 16 , 19 ].…”

“…Five papers examined the role of specialist PC [ 13 , 16–18 ]. Five looked explicitly at service design and access to care [ 13 , 15–18 ]. One paper [ 15 ] looked at the role of information and support in decision-making, and two [ 14 , 16 ] explored issues surrounding capacity.…”

“…Hudson [ 15 ] explored the role of informational continuity on achieving patients’ preferred PoD. This was defined as ‘coordinated, comprehensive information sharing’.…”

“…Hudson [ 15 ] described the emotional impact of poor informational continuity on people with PC needs and their families, highlighting how a lack of continuity and reliable access to good information worsened feelings of vulnerability, and contributed to feelings of being lonely and unsupported. De Souza [ 20 ] found a number of incidences where families found discussing future options for PoC and PoD difficult, due to perceived creation of suffering and emotional burden on family members.…”

“…Through reviewing the existing literature, we found that certain values and processes were common throughout the process of decision-making [ 15–20 ]. In light of this, a decision-making model was devised ( Figure 2 ).…”