Hospital patients' perspectives on what is essential to enable optimal palliative care: A qualitative study

C Virdun, T Luckett, K Lorenz… - Palliative …, 2020 - journals.sagepub.com
Palliative medicine, 2020journals.sagepub.com
Background: The majority of expected deaths in high income countries occur in hospital
where optimal palliative care cannot be assured. In addition, a large number of patients with
palliative care needs receive inpatient care in their last year of life. International research
has identified domains of inpatient care that patients and carers perceive to be important, but
concrete examples of how these might be operationalised are scarce, and few studies
conducted in the southern hemisphere. Aim: To seek the perspectives of Australian patients …
Background
The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere.
Aim
To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised.
Design
An exploratory qualitative study using semi-structured interviews.
Setting/participants
Participants were recruited through five hospitals in New South Wales, Australia.
Results
Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists.
Conclusions
Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.
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