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BMC Palliative Care
Published in: BMC Palliative Care 1/2019

Open Access 01-12-2019 | Care | Research article

How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? A qualitative interview study

Authors: Isabelle Flierman, Ineke C. Nugteren, Rosanne van Seben, Bianca M. Buurman, Dick L. Willems

Published in: BMC Palliative Care | Issue 1/2019

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Abstract

Background

Early start of palliative care improves the quality of life of eligible patients and their relatives. However, in hospital, patients who could benefit from palliative care are often not identified timely. The aim of this study is to assess how hospital-based nurses and physicians define the palliative phase, how they identify the palliative phase and what difficulties they face.

Methods

Semi-structured interviews were held with ten nurses and 18 physicians working at seven hospitals in the Netherlands. Data was analysed using thematic analysis.

Results

Nurses and physicians feel insecure about how to define the palliative phase and differentiate between an acute and extended phase. Great variation existed in what life expectancy is attributed to each phase. A variety of ways to identify the palliative phase were described: 1) Prognostication. 2) Treatment trade-off. 3) Assessment of patients’ preferences and needs. 4) Interprofessional collaboration. Professionals base prognostication on their experience but also search for clinical indicators. When benefits of treatment no longer outweigh the negatives, this was considered an, albeit late, identification point. To start a conversation on a patients’ palliative care needs was found to be difficult. Therefore, some respondents wait for patients to vocalize preferences themselves. Many professionals rely on interprofessional collaboration for identification, however uncertainty exist about responsibilities. Difficulties in identification occurred because of variance in definitions, unpredictability of non-oncological diseases, focus on treatment and difficulties in communication and collaboration.

Conclusion

These results provide insight into the challenges and difficulties hospital-based professionals experience in timely identification of patients with palliative care needs.
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Literature
1.
Davis MP, Temel JS, Balboni T, Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med. 2015;4(3):99–121.PubMed
2.
Rabow M, Kvale E, Barbour L, Cassel JB, Cohen S, Jackson V, et al. Moving upstream: a review of the evidence of the impact of outpatient palliative care. J Palliat Med. 2013;16(12):1540–9.PubMedCrossRef
3.
Haun MW, Estel S, Rucker G, Friederich HC, Villalobos M, Thomas M, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017;6:Cd011129.PubMed
4.
5.
Lynn J, Adamson DM. Living well at the end of life: adapting health care to serious chronic illness in old age. Santa Monica: RAND Corporation; 2003.CrossRef
6.
Abarshi EA, Echteld MA, Van den Block L, Donker GA, Deliens L, Onwuteaka-Philipsen BD. Recognising patients who will die in the near future: a nationwide study via the Dutch sentinel network of GPs. Br J Gen Pract. 2011;61(587):e371–8.PubMedPubMedCentralCrossRef
7.
Claessen SJ, Echteld MA, Francke AL, Van den Block L, Donker GA, Deliens L. Important treatment aims at the end of life: a nationwide study among GPs. Br J Gen Pract. 2012;62(595):e121–6.PubMedCrossRef
8.
9.
Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med. 2017;15(1):102.PubMedPubMedCentralCrossRef
10.
Overbeek A, Van den Block L, Korfage IJ, Penders YWH, van der Heide A, Rietjens JAC. Admissions to inpatient care facilities in the last year of life of community-dwelling older people in Europe. Eur J Pub Health. 2017;27(5):814–21.CrossRef
11.
12.
Clark D, Armstrong M, Allan A, Graham F, Carnon A, Isles C. Imminence of death among hospital inpatients: prevalent cohort study. Palliat Med. 2014;28(6):474–9.PubMedPubMedCentralCrossRef
13.
Flojstrup M, Henriksen DP, Brabrand M. An acute hospital admission greatly increases one year mortality - getting sick and ending up in hospital is bad for you: a multicentre retrospective cohort study. Eur J Intern Med. 2017;45:5–7.PubMedCrossRef
14.
Cotogni P, Saini A, De Luca A. In-hospital palliative care: should we need to reconsider what role hospitals should have in patients with end-stage disease or advanced Cancer? J Clin Med. 2018;7(2).PubMedCentralCrossRef
15.
Beernaert K, Deliens L, De Vleminck A, Devroey D, Pardon K, Van den Block L, et al. Early identification of palliative care needs by family physicians: a qualitative study of barriers and facilitators from the perspective of family physicians, community nurses, and patients. Palliat Med. 2014;28(6):480–90.PubMedCrossRef
16.
Claessen SJ, Francke AL, Engels Y, Deliens L. How do GPs identify a need for palliative care in their patients? An interview study. BMC Fam Pract. 2013;14:42.PubMedPubMedCentralCrossRef
17.
Harrison N, Cavers D, Campbell C, Murray SA. Are UK primary care teams formally identifying patients for palliative care before they die? Br J Gen Pract. 2012;62(598):e344–52.PubMedPubMedCentralCrossRef
18.
Dalgaard KM, Bergenholtz H, Nielsen ME, Timm H. Early integration of palliative care in hospitals: a systematic review on methods, barriers, and outcome. Palliat Support Care. 2014;12(6):495–513.PubMedCrossRef
19.
Murray S, Boyd K. Using the 'surprise question' can identify people with advanced heart failure and COPD who would benefit from a palliative care approach. Palliat Med. 2011;25(4):382.PubMedCrossRef
20.
Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the supportive and palliative care indicators tool (SPICT): a mixed-methods study. BMJ Support Palliat Care. 2014;4(3):285–90.PubMedCrossRef
21.
Thoonsen B, Engels Y, van Rijswijk E, Verhagen S, van Weel C, Groot M, et al. Early identification of palliative care patients in general practice: development of RADboud indicators for PAlliative care needs (RADPAC). Br J Gen Pract. 2012;62(602):e625–31.PubMedPubMedCentralCrossRef
22.
Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.PubMedCrossRef
23.
Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119(10):1442–52.PubMedCrossRef
24.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed
25.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
26.
MAXQDA. software for qualitative data analysis. VERBI software – consult – Sozialforschung GmbH, Berlin, Germany.1989–2018.
27.
Guest G, Bunce A, Johnson L. How many interviews are enough? Field Methods. 2006;18(1):59–82.CrossRef
28.
Shipman C, Gysels M, White P, Worth A, Murray SA, Barclay S, et al. Improving generalist end of life care: national consultation with practitioners, commissioners, academics, and service user groups. BMJ. 2008;337:a1720.PubMedPubMedCentralCrossRef
29.
Mitchell H, Noble S, Finlay I, Nelson A. Defining the palliative care patient: its challenges and implications for service delivery. BMJ Support Palliat Care. 2015;5(4):328–34.PubMedCrossRef
30.
Van Mechelen W, Aertgeerts B, De Ceulaer K, Thoonsen B, Vermandere M, Warmenhoven F, et al. Defining the palliative care patient: a systematic review. Palliat Med. 2013;27(3):197–208.PubMedCrossRef
31.
Horlait M, Chambaere K, Pardon K, Deliens L, Van Belle S. What are the barriers faced by medical oncologists in initiating discussion of palliative care? A qualitative study in Flanders, Belgium. Support Care Cancer. 2016;24(9):3873–81.PubMedCrossRef
32.
Zheng L, Finucane A, Oxenham D, McLoughlin P, McCutcheon H, Murray S. How good is primary care at identifying patients who need palliative care? A mixed methods study. Eur J Palliat Care. 2013;20:216–22.
33.
Wichmann AB, van Dam H, Thoonsen B, Boer TA, Engels Y, Groenewoud AS. Advance care planning conversations with palliative patients: looking through the GP’s eyes. BMC Fam Pract. 2018;19(1):184.PubMedPubMedCentralCrossRef
34.
Gadoud A, Kane E, Macleod U, Ansell P, Oliver S, Johnson M. Palliative care among heart failure patients in primary care: a comparison to cancer patients using English family practice data. PLoS One. 2014;9(11):e113188.PubMedPubMedCentralCrossRef
35.
Stewart S, McMurray JJV. Palliative care for heart failure : time to move beyond treating and curing to improving the end of life. BMJ. 2002;325(7370):915–6.PubMedPubMedCentralCrossRef
36.
White N, Reid F, Harris A, Harries P, Stone P. A systematic review of predictions of survival in palliative care: how accurate are clinicians and who are the experts? PLoS One. 2016;11(8):e0161407.PubMedPubMedCentralCrossRef
37.
Kendall M, Buckingham S, Ferguson S, Hewitt N, Pinnock H. We need to stop looking for something that is not there. NPJ Prim Care Respir Med. 2014;24:14031.PubMedPubMedCentralCrossRef
38.
Tang CJ, Chan SW, Zhou WT, Liaw SY. Collaboration between hospital physicians and nurses: an integrated literature review. Int Nurs Rev. 2013;60(3):291–302.PubMedCrossRef
39.
Gott M, Ingleton C, Bennett MI, Gardiner C. Transitions to palliative care in acute hospitals in England: qualitative study. BMJ Support Palliat Care. 2011;1(1):42–8.PubMed
40.
Tavares N, Jarrett N, Hunt K, Wilkinson T. Palliative and end-of-life care conversations in COPD: a systematic literature review. ERJ Open Res. 2017;3(2):00068-2016.PubMedPubMedCentralCrossRef
41.
Lovell A, Yates P. Advance care planning in palliative care: a systematic literature review of the contextual factors influencing its uptake 2008-2012. Palliat Med. 2014;28(8):1026–35.PubMedCrossRef
42.
Seamark D, Blake S, Seamark C, Hyland ME, Greaves C, Pinnuck M, et al. Is hospitalisation for COPD an opportunity for advance care planning? A qualitative study. Prim Care Respir J. 2012;21(3):261–6.PubMedPubMedCentralCrossRef
43.
Oosterink JJ, Oosterveld-Vlug MG, Glaudemans JJ, Pasman HR, Willems DL, Onwuteaka-Philipsen BD. Interprofessional communication between oncologic specialists and general practitioners on end-of-life issues needs improvement. Fam Pract. 2016;33(6):727–32.PubMedCrossRef
44.
IKNL/Palliactief. Kwaliteitskader palliatieve zorg Nederland. 2017.
45.
46.
Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NK. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ. 2017;189(13):E484–e93.PubMedPubMedCentralCrossRef
47.
De Bock R, Van Den Noortgate N, Piers R. Validation of the supportive and palliative care indicators tool in a geriatric population. J Palliat Med. 2018;21(2):220–4.PubMedCrossRef
48.
Metadata
Title
How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? A qualitative interview study
Authors
Isabelle Flierman
Ineke C. Nugteren
Rosanne van Seben
Bianca M. Buurman
Dick L. Willems
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Palliative Care / Issue 1/2019
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-019-0439-0

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