Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review

• Published in: BMJ open 2019-05, Vol.9 (5), p.e027323-e027323
• Main Authors: Hudson, Briony F, Best, Sabine, Stone, Patrick, Noble, Thomas (Bill)
• Format: Article
• Language: English
• Subjects: Attitude to Death; Cancer; Caregivers; Caregivers - psychology; Caregivers - statistics & numerical data; Continuity of care; Continuity of Patient Care; Emotions; Family Health; Family physicians; Health care access; Hospice care; Hospitalization - statistics & numerical data; Hospitals; Humans; Mixed methods research; Needs Assessment; Palliative Care; Palliative Care - methods; Palliative Care - psychology; Palliative Care - statistics & numerical data; Patient Preference; Patient Satisfaction; Primary care; Qualitative research; Research Design
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-027323

ObjectiveTo identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature.DesignA mixed methods rapid review.MethodsPUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned.OutcomesThe impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions.Results18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity.ConclusionsThis rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.