Health Care Providers' Views on the Transition Between Hospital and Primary Care in Patients in the Palliative Phase: A Qualitative Description Study

• Published in: Journal of pain and symptom management 2020-08, Vol.60 (2), p.372-380.e1
• Main Authors: Flierman, Isabelle, van Seben, Rosanne, van Rijn, Marjon, Poels, Marjolein, Buurman, Bianca M., Willems, Dick L.
• Format: Article
• Language: English
• Subjects: care transitions; Clinical outcomes; Communication; Death & dying; End of life decisions; Focus groups; Handover; Health problems; Health status; interprofessional collaboration; Medical personnel; Nurses; Palliative care; Patient communication; Patients; Physicians; Primary care; Psychosocial factors; Qualitative research; Uncertainty; Vulnerability
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2020.02.018

Inadequate handovers between hospital and home can lead to adverse health outcomes. A group particularly at risk is patients at the end of life because of complex health problems, frequent care transitions, and involvement of many professionals. To investigate health care providers' views and experiences with regard to the transition from hospital to primary care in palliative care. This was a descriptive qualitative study. Three focus group discussions were held with 28 nurses and two focus groups with nine physicians. Participants were recruited from primary and hospital care. The focus groups were audiorecorded, transcribed verbatim, and analyzed thematically. The following themes emerged from the data: lack of identification of and communication about the last phase of life; incomplete and insufficient handover; and uncertainty about responsibilities. Professionals emphasize the importance of proper handovers and transitional processes in these vulnerable patients. The transition between hospital to primary care is hindered by a lack of identification of the palliative phase and uncertainties about patient awareness. Direct communication between professionals is needed but lacking. The handover itself is currently primarily focused on physical aspects where psychosocial aspects were also found necessary. Furthermore, uncertainties with regard to physicians' responsibility for the patient seem to further hinder professionals in the transitional process. Efforts should be made to enhance knowledge and skills around identification of palliative needs and communication with patients about the end of life, especially in the hospital setting.