The nature of, and reasons for, ‘inappropriate’ hospitalisations among patients with palliative care needs: A qualitative exploration of the views of generalist palliative care providers
- 7 January 2013
- journal article
- research article
- Published by SAGE Publications in Palliative Medicine
- Vol. 27 (8), 747-756
- https://doi.org/10.1177/0269216312469263
Abstract
Recent studies have concluded that there is significant potential to reduce the extent of ‘inappropriate’ hospitalisations among patients with palliative care needs. However, the nature of, and reasons for, inappropriate hospitalisations within a palliative care context is under-explored. To explore the opinions of ‘generalist’ palliative care providers regarding the nature of, and reasons for, inappropriate admissions among hospital inpatients with palliative care needs. Qualitative study with data collected via individual interviews and focus groups. Participants (n = 41) comprised ‘generalist’ palliative care providers working in acute hospital and community settings. One District Health Board in an urban area of New Zealand. The majority of participants discussed ‘appropriateness’ in relation to their own understanding of a good death, which typically involved care being delivered in a ‘homely’ environment, from known people. Differing attitudes among cultural groups were also evident. The following reasons for inappropriate admissions were identified: family carers being unable to cope, the ‘rescue culture’ of modern medicine, the financing and availability of community services and practice within aged residential care. On the basis of our findings, we recommend a shift to the term ‘potentially avoidable’ admission rather than ‘inappropriate admission’. We also identify an urgent need for debate regarding the role of the acute hospital within a palliative care context. Interventions to reduce hospital admissions within this population must target societal understandings of death and dying within the context of medicalisation, as well as take into account cultural and ethnic diversity in attitudes, if they are to be successful.Keywords
This publication has 14 references indexed in Scilit:
- The contemporary relevance of Glaser and StraussMortality, 2012
- Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statisticsInternational Journal of Public Health, 2012
- Exploring the transition from curative care to palliative care: a systematic review of the literatureBMJ Supportive & Palliative Care, 2011
- The Clinical Course of Advanced DementiaNew England Journal of Medicine, 2009
- Methodological review: measured and reported congruence between preferred and actual place of deathPalliative Medicine, 2009
- End-of-life care in hospital: a descriptive study of all inpatient deaths in 1 yearPalliative Medicine, 2009
- Hospice or home? Expectations of end‐of‐life care among white and Chinese older people in the UKSociology of Health & Illness, 2007
- Needs and experiences of non-English-speaking hospice patients and families in an English-speaking countryAmerican Journal of Hospice and Palliative Medicine®, 2001
- Place of Care in Advanced Cancer: A Qualitative Systematic Literature Review of Patient PreferencesJournal of Palliative Medicine, 2000
- Qualitative Research: Introducing focus groupsBMJ, 1995