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Transitions to palliative care in acute hospitals in England: qualitative study

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1773 (Published 29 March 2011) Cite this as: BMJ 2011;342:d1773
  1. Merryn Gott, professor of health sciences1,
  2. Christine Ingleton, professor of palliative care nursing2,
  3. Michael I Bennett, professor of palliative medicine3,
  4. Clare Gardiner, research fellow4
  1. 1School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, New Zealand
  2. 2School of Nursing and Midwifery, Northern General Hospital, University of Sheffield, UK
  3. 3International Observatory on End of Life Care, School of Health and Medicine, Lancaster University, UK
  4. 4School of Nursing and Midwifery, St Luke’s Hospice, University of Sheffield, UK
  1. Correspondence to: M Gott m.gott{at}auckland.ac.nz
  • Accepted 6 January 2011

Abstract

Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.

Design Qualitative study.

Setting Secondary or primary care settings in two contrasting areas of England.

Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.

Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.

Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.

Footnotes

  • We thank the participants for their time.

  • Contributors: MG designed the study, is co-principal investigator for the study, led the analyses presented in this paper, and wrote the first draft. CI helped design the study, is co-principal investigator, and revised later drafts of the paper. MIB contributed to the study design, is a co-investigator for the project, and revised later drafts of the paper. CG undertook the data collection, contributed to the analysis, and revised later drafts of the paper. MG is guarantor.

  • Funding: The study was funded by the National Institute of Health Research under the Service Delivery and Organisation programme. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Department of Health. All authors declare independence from the study funders.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Sheffield research ethics committee.

  • Data sharing: No additional data available.

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