Palliative care physicians’ perspectives on transferring patients to nursing homes and communication strategies to facilitate this transition: A qualitative study

Abstract

Background: As modern medicine extends the life expectancy of patients with life-limiting illnesses and health system resource pressures intensify, palliative care physicians increasingly need to transfer stable patients from specialist palliative care units to nursing homes. The experience of palliative care physicians in decision-making and communicating with patients and families about the need for this transition is underexplored in the literature. Aim: This study aimed to explore the experiences of and communication techniques used by palliative care physicians as they consider and discuss nursing home placements for their patients. Design: A qualitative approach using semi-structured interviews was used. Interviews were transcribed verbatim and analysed using thematic analysis. Setting/participants: Purposive sampling was used to recruit 18 Australian palliative care physicians known for their interest or strength in communication skills across a range of palliative care settings. Results: Themes emerged from domains of physician experience (abandonment, systemic pressures, prognostic uncertainty, exacerbation of loss, and restoring resilience) and communication strategies (forecasting, checking in, provide context, and acknowledging grief). Conclusion: This study highlights the tension Australian palliative care physicians experience when transferring palliative care patients to nursing home and the complexity involved in decision-making. Physicians identified several communication strategies to engage patients and families to ease the transition.

Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study

“…The process is often associated with feelings of abandonment and guilt in patients and families. 12 It is imperative that discussions surrounding nursing home transfer are communicated and managed as sensitively as possible. 13 Other evidence highlighted that patients wanted to receive information tailored to their own situation.…”

Factors That Determine the Experience of Transition to an Inpatient Palliative Care Unit for Patients and Caregivers: A Qualitative Study

“…It has been suggested that each transfer is a threat to Continuity of care. 15 Some participants in our study reported suboptimal coordination of care during the transition to PCU. Whether this was being promised a private room by the transferring facility which did not materialize or not having all relevant information transferred, it was a source of anxiety for some participants.…”

“…Our results are consistent with previous work that demonstrates how the effective use of iterative communication strategies about what to expect in a new palliative care setting can ease complex care transitions for patients. 14 , 15 …”

Doctors’ Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study

“…Research with patients and families about care in hospitals suggests patients receive poor management of symptoms and that family members can find it difficult to engage with health professionals in making decisions about care and management of end-of-life [19]. Various studies have identified communication issues as a fundamental challenge, both within the hospital setting and more generally [18][19][20][21][22][23]. Clear, comprehensive and timely communication is crucial to facilitate a 'good death' [22], and prevent inappropriate treatment at the end of a patient's life [21].…”