Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

Abstract

Background:Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally.Aim:To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die.Design:Exploratory two-stage qualitative studySetting/participants:Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews.Findings:The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking.Conclusion:There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

Frontline Healthcare Staffs’ Experience of Organizing Complex Hospital Discharges: An Ethnographic Study

“…Participants reported being unable to manage facilitating patients to experience a good death, that is a death that "encompass[es] no suffering (both from physical and psychosocial distress), dying at a preferred place, being around family, not being a burden to others and a 'sense of completion of their familial responsibilities during the last days of life" (Vencatasalu, Clarke & Atkinson, 2015, p. 1677. Although previous research has demonstrated the interplay of patient and system related factors on transferring patients from critical care home to die (Coombs, Long-Sutehall, Darlington & Richardson, 2015), our analysis shows that wider structural factors frequently contribute to difficulties in organising such complex discharges (Ingleton, Payne, Sargeant & Seymour, 2009). …”

‘I cried too’ – Allowing ICU nurses to grieve when patients die

“…It is encouraging that, despite an increase in severity of disease, the odds of intensive care unit (ICU) mortality have reduced (Vincent et al 2018). For those patients who are unlikely to survive, there is also increasing evidence of more open discussions about priorities of care, as reflected in scientific and conceptual papers (Coombs et al 2015, Van del Bulcke et al, 2018. Despite this progress towards more explicit communication about death and dying with patients and families in ICU, studies conducted by Jang & colleagues (2019) and Betriana & colleagues (2019) illustrate that this open-ness stops short of acknowledging the impact of a patient's death on health care professionals.…”

Going home to die from critical care: A case study

“…Cases reporting on the discharge of critically, but also terminally, ill patients are more limited and are still rare events in the United Kingdom . This is despite the fact that mortality in critical care is relatively high, and it is an accepted opinion that people would prefer to die at home .…”