End-of-life and immediate postdeath acute hospital interventions: scoping review

Abstract

BackgroundHospital remains the most common place of death in the UK, but there are ongoing concerns about the quality of end-of-life care provision in this setting. Evaluation of interventions in the last days of life or after a bereavement is methodologically and ethically challenging.AimThe aim was to describe interventions at the very end of life and in the immediate bereavement period in acute hospitals, with a particular focus on how these are evaluated.MethodA scoping review was conducted. Studies were restricted to peer-reviewed original research or literature reviews, published between 2011 and 2021, and written in the English language. Databases searched were CINAHL, Medline and Psychinfo.ResultsFrom the search findings, 42 studies were reviewed, including quantitative (n=7), qualitative (n=14), mixed method (n=4) and literature reviews (n=17). Much of the current research about hospital-based bereavement care is derived from the intensive and critical care settings. Three themes were identified: (1) person-centred/family-centred care (memorialisation), (2) institutional approaches (quality of the environment, leadership, system-wide approaches and culture), (3) infrastructure and support systems (transdisciplinary working and staff support). There were limited studies on interventions to support staff.ConclusionCurrently, there are few comprehensive tools for evaluating complex service interventions in a way that provides meaningful transferable data. Quantitative studies do not capture the complexity inherent in this form of care. Further qualitative studies would offer important insights into the interventions.

Implementation and perceived impact of the SWAN model of end-of-life and bereavement care: a realist evaluation

“…32 Participants at both the Stage 1 and 2 Trusts reported the embedding of memory-making activities; these types of interventions were found to be valued by bereaved families in previous qualitative research. 19 The SWAN model of care improved the overall attention to end-of-life and bereavement care, as demonstrated through the qualitative findings as well as routinely collected data such as end-of-life care plans as well as timely mortuary transfer, which then enabled potential tissue donation, as desired by families, in accordance with their loved ones' preferences.…”

“…Previous evaluations of end-of-life and bereavement care are scarce and are predominantly survey-based 19 ; in contrast this evaluation, using a realistic approach, included qualitative interview data as well as analyses of routinely collected qualitative and quantitative data. The use of a mixed method realist evaluation captured the nuances of what it is about the SWAN model that brings about change and the context (‘for whom’ and ‘in what circumstances’) SWAN works.…”

“…Outcomes from the review are published elsewhere. 19 This review highlighted limitations in the quality and quantity of research available in relation to evaluating services and interventions at the end-of-life. However, from the literature identified, there are key mechanisms that appear to be of value, with three themes identified: person and family centred care, institutional approaches and infrastructure; these formed the programme theory for the evaluation.…”

“…In general, evaluation of end-of-life and bereavement care is considered ethically challenging 18 and robust evaluations of hospital based end-of-life and bereavement services are scarce. 19 This paper presents findings from a realist evaluation of the SWAN model.…”

How can the priorities of older, frail patients and their carers be used to inform policy and practice at the end of life? Insights from qualitative research across multiple settings

“…Interventions at the EoL are underinvestigated due, in part, to the considerable methodological and ethical challenges, meaning that patient experiences often go unheard—this research therefore fills an important gap in literature. 10 This article draws on a research project which explored the national implementation of EoL policy, in which a wide range of stakeholders were interviewed to explore alignment of policy priorities in each group, and the broader study is reported elsewhere. 6 11 The paper focusses on the voice of older people aged 75+ years, identified by clinicians as being at the EoL, and their carers, to reflect on how to align current system pressures with patient wishes.…”