Palliative Care in the Community

Munday, Daniel; Charlton, Rodger

doi:10.1002/9781118426869.ch2

Cited by 4 publications

(5 citation statements)

References 79 publications

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“…The relevance of continuity was evident on a number of levels, supporting existing work20 21 that sought to define and explore dimensions of continuity in general, and in detail, on continuity in palliative care 22. Freeman and Hughes’ recent definition of two key types of continuity—relationship and management (box 3) is useful in the context of this article's findings 23…”

Section: Methodssupporting

confidence: 57%

Discontinuity of care at end of life: a qualitative exploration of OOH end of life care

Leydon

Shergill

Austin

et al. 2013

BMJ Support Palliat Care

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Section: Methodssupporting

confidence: 57%

Discontinuity of care at end of life: a qualitative exploration of OOH end of life care

Leydon

Shergill

Austin

et al. 2013

BMJ Support Palliat Care

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“…The interviews explored the following areas: the symptoms the patient was experiencing and their progress over time, social context and medical management prior to admission; the patient and carer's roles in self-management; healthcare staff’s involvement in the critical incident; process and experience of admission; and identification of factors that could potentially have prevented the emergency admission. The interview schedules were developed by drawing on a previous study of emergency admission, 17 a brief exploration of the health service contexts by key informant interviews with clinicians based at the recruitment hospital sites, and a literature review to explore the wider context.…”

Section: Methodsmentioning

confidence: 99%

“… 16 Few studies have explored reasons for emergency admission, or the process of decision-making, from the perspective of patients with advanced chronic life-limiting illnesses. 16 17 …”

Section: Introductionmentioning

confidence: 99%

Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

et al. 2016

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ObjectivesThe high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital.Setting3 UK hospitals located in different urban and rural settings.DesignQualitative critical incident study.Participants24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients’ care.ResultsThe analysis of patient, carer and professionals’ interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms.ConclusionsPatients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as ‘inappropriate’.

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“…). At‐risk registers (Munday & Dale ) should be developed for patients on long‐term dialysis and with transplants, and suggested triggers may include two or more non‐elective admissions in the last year; weight loss of 10% on dialysis not connected with fluid losses over six months; cognitive decline that worries family and staff and use of the ‘surprise question’—‘would you be surprised if this patient were to die in the next 6 to 12 months’? (NHS Kidney Care and the NHS National End of Life Care Programme ).…”

Section: Discussionmentioning

confidence: 99%

An Appraisal of End‐of‐life Care in Persons With Chronic Kidney Disease Dying in Hospital Wards

Noble

Brown

Shields

et al. 2014

Journal of Renal Care

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SUMMARY Aim To review end‐of‐life care provided by renal healthcare professionals to hospital in‐patients with chronic kidney disease, and their carers, over a 12‐month period in Northern Ireland. Methods Retrospective review of 100 patients. Results Mean age at death was 72 years (19–95) and 56% were male. Eighty three percent of patients had a ‘Not For Attempted Resuscitation’ order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. No patients had an advanced care plan, although 42% had commenced the Liverpool Care Pathway for the Dying Patient. Patients suffered excessive end‐of‐life symptoms. In addition, there was limited documentation of carer involvement and carer needs were not formally assessed. Conclusion End‐of‐life care for patients with advanced chronic renal disease can be enhanced. There is significant variation in the recording of discussions regarding impending death and little preparation. There is poor recording of the patients' wishes regarding death. Those with declining functional status, including those frequently admitted to hospital require holistic assessment regarding end‐of‐life needs. More effective communication between the patient, family and multi‐professional team is required for patients who are dying and those caring for them.

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Palliative Care in the Community

Cited by 4 publications

References 79 publications

Discontinuity of care at end of life: a qualitative exploration of OOH end of life care

Discontinuity of care at end of life: a qualitative exploration of OOH end of life care

Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

An Appraisal of End‐of‐life Care in Persons With Chronic Kidney Disease Dying in Hospital Wards

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