The nature of, and reasons for, ‘inappropriate’ hospitalisations among patients with palliative care needs: A qualitative exploration of the views of generalist palliative care providers

Gott, Merryn; Frey, Rosemary; Robinson, Jackie; Boyd, Michal; O’Callaghan, Anne; Richards, Naomi; Snow, Barry

doi:10.1177/0269216312469263

Cited by 56 publications

(72 citation statements)

References 16 publications

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“…Previous international research examining avoidable hospitalisations among ARC residents has concluded that insufficient communication between health professionals, residential care staff and residents and their families represents a key contributory factor 9. Similar findings have been reported in New Zealand,10 the setting for the study reported in this paper.…”

Section: Introductionsupporting

confidence: 84%

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

Frey

Boyd

Foster

et al. 2016

BMJ Support Palliat Care

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Section: Introductionsupporting

confidence: 84%

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

Frey

Boyd

Foster

et al. 2016

BMJ Support Palliat Care

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“…Society in general is also less familiar with home deaths 19 21. If patients live alone, they are more likely to be admitted for end-of-life care 9 24.…”

Section: Discussionmentioning

confidence: 99%

“…If home is not an option, it is disingenuous to offer them a choice of location of preference without being able to enhance the community support available for these individuals when required. Female family members have in the past automatically assumed the care provider role, it is unsurprising therefore that if they become ill they are more likely to be admitted and not have a home death 19 25. Female family members are more likely to be in paid employment than a century ago which can provide challenges for families and carers to balance this caring role with work and other commitments, particularly in the face of an uncertain prognosis 16.…”

Section: Discussionmentioning

confidence: 99%

The importance of identifying preferred place of death

Ali

Capel²,

Jones

et al. 2015

BMJ Support Palliat Care

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ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.

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“…The involvement of general practitioners (GPs) is important both in the early recognition of the need for palliative care and in ensuring the continuity of care (Almaawiy et al, 2014;Aabom et al, 2006;Van den Block et al, 2007;De Roo et al, 2014, Henson et al, 2016Gott et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Intensity of integrated cancer palliative care plans and end-of-life acute medical hospitalisation among cancer patient in Northern Italy

et al. 2017

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A high hospital utilisation at the end of life (EOL) is an indicator of suboptimal quality of health care. We evaluated the impact of the intensity of different Integrated Cancer Palliative Care (ICPC) plans on EOL acute medical hospitalisation among cancer decedents. Decedents of cancer aged 18–84 years, who were residents in two Italian regions, were investigated through integrated administrative data. Outcomes considered were prolonged hospital stay for medical reasons, 2+ hospitalisations during the last month of life and hospital death. The ICPC plans instituted 90 to 31 days before death represented the main exposure of interest. Other variables considered were gender, age class at death, marital status, recent hospitalisation and primary cancer site. Among 6,698 patients included in ICPC plans, 44.3% presented at least one critical outcome indicator; among these, 76.5% died in hospital, 60.3% had a prolonged (12+ days) medical hospitalisation, 19.1% had 2+ hospitalisations at the EOL. These outcomes showed a strong dose–response effect with the intensity of the ICPC plans, which is already evident at levels of moderate intensity. A well‐ICPC approach can be very effective—beginning at low levels of intensity of care—in reducing the percentage of patients spending many days or dying in hospital.

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The nature of, and reasons for, ‘inappropriate’ hospitalisations among patients with palliative care needs: A qualitative exploration of the views of generalist palliative care providers

Cited by 56 publications

References 16 publications

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

The importance of identifying preferred place of death

Intensity of integrated cancer palliative care plans and end-of-life acute medical hospitalisation among cancer patient in Northern Italy

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