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Weetman K, MacArtney JI, Grimley C, Bailey C, Dale J. Improving patients', carers' and primary care healthcare professionals' experiences of discharge communication from specialist palliative care to community settings: a protocol for a qualitative interview study. BMC Palliat Care 2024; 23:156. [PMID: 38902635 PMCID: PMC11191294 DOI: 10.1186/s12904-024-01451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/07/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Patients who have benefited from specialist intervention during periods of acute/complex palliative care needs often transition from specialist-to-primary care once such needs have been controlled. Effective communication between services is central to co-ordination of care to avoid the potential consequences of unmet needs, fragmented care, and poor patient and family experience. Discharge communications are a key component of care transitions. However, little is known about the experiences of those primarily receiving these communications, to include patients', carers' and primary care healthcare professionals. This study aims to have a better understanding of how the discharge communications from specialist palliative care services to primary care are experienced by patients, carers, and healthcare professionals, and how these communications might be improved to support effective patient-centred care. METHODS This is a 15-month qualitative study. We will interview 30 adult patients and carers and 15 healthcare professionals (n = 45). We will seek a range of experiences of discharge communication by using a maximum variation approach to sampling, including purposively recruiting people from a range of demographic backgrounds from 4-6 specialist palliative care services (hospitals and hospices) as well as 5-7 general practices. Interview data will be analysed using a reflexive thematic approach and will involve input from the research and advisory team. Working with clinicians, commissioners, and PPI representatives we will co-produce a list of recommendations for discharge communication from specialist palliative care. DISCUSSION Data collection may be limited by the need to be sensitive to participants' wellbeing needs. Study findings will be shared through academic publications and presentations. We will draft principles for how specialist palliative care clinicians can best communicate discharge with patients, carers, and primary care clinicians. These will be shared with clinicians, policy makers, commissioners, and PPI representatives and key stakeholders and organisations (e.g. Hospice UK) and on social media. Key outputs will be recommendations for a specialist palliative care discharge proforma. TRIAL REGISTRATION Registered in ISRCTN Registry on 29.12.2023 ref: ISRCTN18098027.
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Affiliation(s)
- Katharine Weetman
- Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK.
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
| | - John I MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | - Catherine Grimley
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Cara Bailey
- Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
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Martin D, Weetman K. Writing letters to patients attending psychiatry clinics. BMJ 2023; 383:p2857. [PMID: 38049178 DOI: 10.1136/bmj.p2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Dave Martin
- Avon and Wiltshire Mental Health Partnership NHS Trust
- Centre for Academic Mental Health, University of Bristol
| | - Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, University of Birmingham
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick
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Weetman K, Dale J, Mitchell SJ, Ferguson C, Finucane AM, Buckle P, Arnold E, Clarke G, Karakitsiou DE, McConnell T, Sanyal N, Schuberth A, Tindle G, Perry R, Grewal B, Patynowska KA, MacArtney JI. Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study. Palliat Care 2022; 21:155. [PMID: 36064662 PMCID: PMC9444706 DOI: 10.1186/s12904-022-01038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01038-8.
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Affiliation(s)
- Katharine Weetman
- Interactive Studies Unit, Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK. .,Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Claire Ferguson
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | - Anne M Finucane
- Marie Curie Hospice Edinburgh, Edinburgh, UK.,The University of Edinburgh School of Health in Social Science, Clinical Psychology, Edinburgh, UK
| | - Peter Buckle
- Marie Curie Research Voices Group, Marie Curie, England, London, UK
| | | | - Gemma Clarke
- Marie Curie Hospice Bradford, Bradford, UK.,University of Leeds, Academic Unit of Palliative Care, Leeds, West Yorkshire, UK
| | | | - Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK.,Queen's University Belfast School of Nursing and Midwifery, Belfast, UK
| | - Nikhil Sanyal
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | - Georgia Tindle
- Marie Curie Hospice Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Rachel Perry
- Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
| | | | | | - John I MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.,Marie Curie Hospice West Midlands, Solihull, West Midlands, UK
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Murphy M, Wong G, Scott A, Wilson V, Salisbury C. The person-based development and realist evaluation of a summary report for GP consultations. NIHR OPEN RESEARCH 2022; 2:20. [PMID: 35935674 PMCID: PMC7613240 DOI: 10.3310/nihropenres.13258.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Use of telephone, video and e-consultations is increasing. These can make consultations more transactional. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework. The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the summary report. Methods A person-based approach was used to develop the summary report. An electronic protocol was designed to automatically generate the report after GPs complete a clinical template in the patient record. This was tested with 45 patients in 3 rounds each, with iterative adjustments made based on feedback after each round. Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results Conclusions The person-based approach was successful. The summary report creates clarity, empowerment and reassurance in certain consultations and patients. As it takes a few minutes per patient, GPs prefer to select patients who will benefit most.
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