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Communication of palliative care needs in discharge letters from hospice providers to primary care : a multisite sequential explanatory mixed methods study
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Weetman, Katharine, Dale, Jeremy, Mitchell, Sarah J., Ferguson, Claire, Finucane, Anne M., Buckle, Peter, Arnold, Elizabeth, Clarke, Gemma, Karakitsiou, Despoina-Elvira, McConnell, Tracey, Sanyal, Nikhil, Schuberth, Anna, Tindle, Georgia, Perry, Rachel, Grewal, Bhajneek, Patynowska, Katarzyna A. and MacArtney, John I. (2022) Communication of palliative care needs in discharge letters from hospice providers to primary care : a multisite sequential explanatory mixed methods study. BMC Palliative Care, 21 (1). doi:10.1186/s12904-022-01038-8 ISSN 1472-684X.
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WRAP-Communication-of-palliative-care-needs-in-discharge-letters-from-hospice-providers-to-primary-care-Weetman-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1422Kb) | Preview |
Official URL: http://dx.doi.org/10.1186/s12904-022-01038-8
Abstract
Background
The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges.
Methods
An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care.
Results
We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”.
Conclusions
The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Academic Primary Care Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Palliative treatment, Hospice care, Patient discharge instructions, Hospitals -- After care | ||||||||
| Journal or Publication Title: | BMC Palliative Care | ||||||||
| Publisher: | BioMed Central Ltd. | ||||||||
| ISSN: | 1472-684X | ||||||||
| Official Date: | 6 September 2022 | ||||||||
| Dates: |
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| Volume: | 21 | ||||||||
| Number: | 1 | ||||||||
| DOI: | 10.1186/s12904-022-01038-8 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 27 September 2022 | ||||||||
| Date of first compliant Open Access: | 28 September 2022 | ||||||||
| RIOXX Funder/Project Grant: |
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