Health Care Providers' Views on the Transition Between Hospital and Primary Care in Patients in the Palliative Phase: A Qualitative Description Study

Flierman, Isabelle; Seben, Rosanne van; Rijn, Marjon van; Poels, Marjolein; Buurman, Bianca M.; Willems, Dick L.

doi:10.1016/j.jpainsymman.2020.02.018

Cited by 15 publications

(16 citation statements)

References 47 publications

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“…Also healthcare professionals sometimes felt uncomfortable due to differences between the hierarchical structure in the hospital environment and primary care. These findings are in line with other studies [ 33 , 34 ]. In a review on advance care planning (ACP) for patients with cancer, Kuusisto et al found differences between hospital physicians and general practitioners in their opinion on the appropriate timing of the start of the palliative phase, and in how to continue conversations about preferences for care throughout the illness process [ 33 ].…”

Section: Discussionsupporting

confidence: 94%

Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands

Engel

Brinkman-Stoppelenburg

Ark

et al. 2021

BMC Palliat Care

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Background In the Netherlands, healthcare professionals attending patients in the last phase of life, can consult an expert palliative care team (PCT) in case of complex problems. There are two types of PCTs: regional PCTs, which are mainly consulted by general practitioners, and hospital PCTs, which are mainly consulted by healthcare professionals in the hospital. Integration of these PCTs is expected to facilitate continuity of care for patients receiving care in different settings. We studied facilitators and barriers in the process of developing and implementing an integrated transmural palliative care consultation service. Methods A multiple case study was performed in four palliative care networks in the southwest Netherlands. We aimed to develop an integrated transmural palliative care consultation service. Researchers were closely observing the process and participated in project team meetings. A within-case analysis was conducted for each network, using the Consolidated Framework for Implementation Research (CFIR). Subsequently, all findings were pooled. Results In each network, project team members thought that the core goal of a transmural consultation service is improvement of continuity of palliative care for patients throughout their illness trajectory. It was nevertheless a challenge for hospital and non-hospital healthcare professionals to arrive at a shared view on goals, activities and working procedures of the transmural consultation service. All project teams experienced the lack of evidence-based guidance on how to organise the service as a barrier. The role of the management of the involved care organisations was sometimes perceived as unsupportive, and different financial reimbursement systems for hospital and out-of-hospital care made implementation of a transmural consultation service complex. Three networks managed to develop and implement a transmural service at some level, one network did not manage to do so. Conclusions Healthcare professionals are motivated to collaborate in a transmural palliative care consultation service, because they believe it can contribute to high-quality palliative care. However, they need more shared views on goals and activities of a transmural consultation service, more guidance on organisational issues and appropriate financing. Further research is needed to provide evidence on benefits and costs of different models of integrated transmural palliative care consultation services.

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Section: Discussionsupporting

confidence: 94%

Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands

Engel

Brinkman-Stoppelenburg

Ark

et al. 2021

BMC Palliat Care

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“…The PalliSupport care pathway was developed according to the MRC-framework [18]. During phase one, the development stage of the intervention, we performed qualitative studies to assess barriers to timely identification of palliative care needs [19] and barriers leading to transitions between community care and the hospital for patients with palliative care needs [20]. Furthermore, in as of yet unpublished studies, we assessed instruments that could aid care professionals in identifying patients in the last year of life and explored the effectiveness of collaborative palliative care teams.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life

Flierman

Rijn

Meij³

et al. 2020

Pilot Feasibility Stud

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Background A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. Methods A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. Results Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals’ roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. Discussion This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.

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“…This stressor is related to a lack of communication between the physician and the nurse about the patient's condition due to physician failure to communicate the information or the absence of the physician in the medical emergency condition (Gray-Toft & Anderson, 1981). Furthermore, inadequate inter-professional communication was found to increase uncertainty in medical responsibility and form a barrier to a better care process (Flierman et al, 2020). That stressor consequently leads to a lack of communication between nurse and patients or their families in relation to how to explain the patient's medical condition, treatment and then what to communicate, when, and how to communicate the information.…”

Section: Discussionmentioning

confidence: 99%

“…This stressor is related to a lack of communication between the physician and the nurse about the patient’s condition due to physician failure to communicate the information or the absence of the physician in the medical emergency condition ( Gray-Toft & Anderson, 1981 ). Furthermore, inadequate inter-professional communication was found to increase uncertainty in medical responsibility and form a barrier to a better care process ( Flierman et al., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Transitional Shock of Multi-Nationality Newly Graduate Nurses in Kuwait

et al. 2021

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Introduction The transitional period of newly graduate nurses became more stressful, different coping mechanisms are essential. Therefore, effective coping with transition-related stress and anxiety is important for the life and professional of those nurses. Objectives To examine the transitional shock through assessing the occupational stress and coping mechanism of multi-nationality newly graduate nurses in Kuwait. Methods A descriptive correlational design was used to identify the occupational stress of the newly graduate nurses (NGNs) and their coping mechanisms during the transitional period to their professional life. All the NGNs were recruited. The total number of participants was 152 nurses. Results Highly significant correlations on almost all stress domains with p-values P < 0.01. We found that “Death and dying” was ranked as the highest stressor with a mean score of 6.20, followed by “uncertainty concerning treatment” with a mean score of 5.59, and in the “Inadequate preparation” was the least stressor with a mean score of 1.64. Conclusion “Religious coping” was the highest-ranked coping mechanism. In conclusion, NGNs have to adjust quickly to the new practical atmosphere encountered in the health care settings by using the proper coping mechanisms techniques.

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Health Care Providers' Views on the Transition Between Hospital and Primary Care in Patients in the Palliative Phase: A Qualitative Description Study

Cited by 15 publications

References 47 publications

Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands

Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands

Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life

Transitional Shock of Multi-Nationality Newly Graduate Nurses in Kuwait

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