1
|
Isenberg SR, Killackey T, Saunders S, Scott M, Ernecoff NC, Bush SH, Varenbut J, Lovrics E, Stern MA, Hsu AT, Bernstein M, Zimmermann C, Wentlandt K, Mahtani R. "Going Home [Is] Just a Feel-Good Idea With No Structure": A Qualitative Exploration of Patient and Family Caregiver Needs When Transitioning From Hospital to Home in Palliative Care. J Pain Symptom Manage 2021; 62:e9-e19. [PMID: 33631330 DOI: 10.1016/j.jpainsymman.2021.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Hospital-to-home transitions, particularly at the end of life, can be challenging for patients and their family caregivers. Therefore, there is a need to better understand gaps in expectations and experiences of these transitions. Theory can inform the creation of an intervention aimed at improving the hospital-to-home transition. OBJECTIVES 1) Explore patients' and caregivers' expectations and subsequent experiences of the hospital-to-home transition while receiving palliative care, and 2) build a substantive grounded theory to enhance the understanding of hospital-to-home transitions from the patient and caregiver perspective. METHODS Longitudinal, prospective qualitative study with semistructured interviews at hospital discharge and three to four weeks after discharge home. We recruited adults receiving inpatient palliative care who were being discharged to home-based palliative care, and their family caregivers from two academic health centers in Toronto, Canada. Thirty-nine participants: 18 patients, 7 caregivers, and 7 patient-caregiver dyads participated. We conducted 52 interviews. We conducted a grounded theory qualitative study. RESULTS Through examining the expectations and subsequent experiences of the transition, and exploring the gaps between them, we identified various transitions needs: health and well-being needs, and practical needs (i.e., transportation, setting up the home for care, care providers in the home). Several enablers and disablers modified the likelihood of needs being met (e.g., caregiver role, education on symptom management, uncertainty, financial resources). CONCLUSION Our substantive grounded theory highlighted potentially measurable constructs that can be further tested. Future interventions should target the enablers/disablers to ensure health and well-being and practical needs are met in the transition.
Collapse
Affiliation(s)
- Sarina R Isenberg
- Bruyère Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Stephanie Saunders
- Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mary Scott
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - Natalie C Ernecoff
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shirley H Bush
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada
| | - Jaymie Varenbut
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada
| | - Emily Lovrics
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada
| | | | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; University of Ottawa, Department of Family Medicine, Ottawa, Canada
| | - Mark Bernstein
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Kirsten Wentlandt
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Canada
| | - Ramona Mahtani
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada
| |
Collapse
|
2
|
Transitions during end-of-life care from the perspective of informal caregivers - A concept analysis using Rodgers' (2000) evolutionary approach. Eur J Oncol Nurs 2021; 51:101899. [PMID: 33545654 DOI: 10.1016/j.ejon.2021.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To produce a conceptual and operational definition of transition, in the context of end-of-life care, as experienced by informal caregivers. METHODS AND SAMPLE The authors used Rodgers' (2000) concept analysis framework to examine this concept. FINDINGS Common themes emerged using Rodgers' (2000) inductive approach confirming transition for informal caregivers at the end of life as a process comprising the presence of trigger(s)/event(s), awareness, instability and engagement/learning while maintaining normality. There was also duration to this process that was often unknown and unpredictable. This concept analysis provides useful insight into understanding the complex dynamics of transition during this period. The primary antecedent of this concept, prompting transition, is a diagnosis of non-curative disease for the patient. In some cases, a gradual realisation rather than a formal diagnosis that the illness has progressed to a non-curative stage, can also be an antecedent. CONCLUSION Transition during end-of-life-care for informal caregivers can be a highly emotional time for this vulnerable cohort. Effective transitioning can ensure a stability and quality end-of-life outcomes, such as a peaceful death, as the awareness and learning that it brings, prompts planning actions for terminal care. Through recognising the findings of this concept analysis, deeper insight may be gained to support the provision of care, by nurses, to informal caregivers, prompting them towards effective transitions that foster the best interest of the patient.
Collapse
|
3
|
Killackey T, Lovrics E, Saunders S, Isenberg SR. Palliative care transitions from acute care to community-based care: A qualitative systematic review of the experiences and perspectives of health care providers. Palliat Med 2020; 34:1316-1331. [PMID: 32772787 DOI: 10.1177/0269216320947601] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Transitioning from the hospital to community is a vulnerable point in patients' care trajectory, yet little is known about this experience within the context of palliative care. While some studies have examined the patient and caregiver experience, no study to date has synthesized the literature on the healthcare provider's perspective on their role and experience facilitating these transitions. AIM The purpose of this systematic review was to understand the experience and perspective of healthcare providers who support the transition of patients receiving palliative care as they move from acute care to community settings. DESIGN A qualitative systematic review of studies using thematic analysis as outlined by Thomas and Harden. PROSPERO: ID # CRD42018109662. DATA SOURCES We searched four databases: MEDLINE, Embase, ProQuest and CINAHL for studies published in English from 1995 until May 22, 2020. Four reviewers screened records using the following selection criteria: (1) peer-reviewed empirical study, (2) adult sample, (3) qualitative study design, (4) perspective of healthcare providers, and (5) included a component of transitions between acute to community-based palliative care. Study findings were analyzed using thematic analysis which entailed: (1) grouping the findings into recurring themes; (2) iteratively referring back to the articles to obtain nuances of the theme and quotations; and (3) defining and solidifying the themes. RESULTS Overall 1,791 studies were identified and 15 met inclusion criteria. Studies were published recently (>2015, n = 12, 80%) and used a range of qualitative methods including semi-structured interviews, focus groups, and field interviews. Three core themes related to the role and experience of healthcare providers were identified: (1) assessing and preparing for transition; (2) organizing and facilitating the logistics of transition; and (3) coordinating and collaborating transitional care across sectors. The majority of studies focused on the discharge process from acute care; there was a lack of studies exploring the experiences of healthcare providers in the community who receive patients from acute care and provide them with palliative care at home. CONCLUSION This review identified studies from a range of relatively high-income countries that included a diverse sample of healthcare providers. The results indicate that healthcare providers experience multiple complex roles during the transition facilitation process, and future research should examine how to better assist clinicians in supporting these transitions within the context of palliative care provision.
Collapse
Affiliation(s)
- Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Sezgin D, Hendry A, Liew A, O'Donovan M, Salem M, Carriazo AM, López-Samaniego L, Rodríguez-Acuña R, Kennelly S, Illario M, Arnal Carda C, Inzitari M, Hammar T, O'Caoimh R. Transitional palliative care interventions for older adults with advanced non-malignant diseases and frailty: a systematic review. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-02-2020-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PurposeTo identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions.Design/methodology/approachA systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal.FindingsA total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear.Research limitations/implicationsPositive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited.Originality/valueStudies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty.
Collapse
|