Transitions to palliative care in acute hospitals in England: qualitative study: Table 1
Open accessAbstract
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.
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Palliative care is perceived as 'a place to die,' and this stigma is a barrier to timely referrals and to patient acceptance of treatment.
“Patients and health professionals may perceive PC as ‘a place to die,’ and this stigma is a barrier to timely referrals and to patient acceptance of treatment.”
From A phase II study in advanced cancer patients to evaluate the early transition to palliative care (the PREPArE trial): protocol study for a randomized controlled trial. (2015) · cites this paper as [10]
The sections on recognising the transition to palliative care and on communication with patients describe late transitions, prognostic uncertainty and difficulties discussing care. Searches for ‘a place to die,’ stigma, referral delays and treatment acceptance found no passage attributing those barriers to stigma. (LLM, conf=0.70)
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Flagged first, then by citations
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“The inadequate awareness and stigmatization of PC, which is perceived as a place to die, are barriers that complicate the early referral of patients to PC [10,11].”
Background
- Authors
- Gott, M., Ingleton, C., Bennett, M. I., & Gardiner, C.
- Affiliations
- University of Auckland (NZ)
- Northern General Hospital (GB)
- University of Sheffield (GB)
- Corresponding author
- Gott, Merryn
- Venue
- BMJ Supportive & Palliative Care
- Publisher
- BMJ
- Published
- 2011-06
- Volume
- 1
- Issue
- 1
- Pages
- 42-48
- ISSN
- 2045-435X (ISSN-L)
- 2045-4368
- PMC
- PMC3230109
- OpenAlex
- W2129141673
- Cited by
- 157
- References
- 22
- Citations by year
- 2024: 2 · 2023: 5 · 2022: 13 · 2021: 13 · 2020: 14 · 2019: 11 · 2018: 11 · 2017: 15 · 2016: 9 · 2015: 19 · 2014: 17 · 2013: 12 · 2012: 9
- FWCI
- 14.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ Supportive & Palliative Care (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ResearchSpace (University of Auckland) (submittedVersion)
- Funders
- National Institute for Health and Care Research (08/1809/233)
- Service Delivery and Organisation Programme
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- palliative care, transition to palliative care, acute care hospitals, prognosis disclosure, barriers to palliative care, professional hierarchy, communication, hospital discharge, health policy implementation, primary care, secondary care
- MeSH terms
- Acute Disease, Adult, Aged, Communication, Decision Making, Delivery of Health Care, England, Female, Hospitalization, Humans, Interpersonal Relations, Male, Middle Aged, Palliative Care, Patient Care Team, Patient Transfer, Primary Health Care, Professional-Family Relations, Time Factors
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