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Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life

BACKGROUND: A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, name...

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Autores principales: Flierman, Isabelle, van Rijn, Marjon, de Meij, Marike, Poels, Marjolein, Niezink, Dorende M., Willems, Dick L., Buurman, Bianca M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490875/
https://www.ncbi.nlm.nih.gov/pubmed/32944277
http://dx.doi.org/10.1186/s40814-020-00676-0
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author Flierman, Isabelle
van Rijn, Marjon
de Meij, Marike
Poels, Marjolein
Niezink, Dorende M.
Willems, Dick L.
Buurman, Bianca M.
author_facet Flierman, Isabelle
van Rijn, Marjon
de Meij, Marike
Poels, Marjolein
Niezink, Dorende M.
Willems, Dick L.
Buurman, Bianca M.
author_sort Flierman, Isabelle
collection PubMed
description BACKGROUND: A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. METHODS: A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. RESULTS: Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals’ roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. DISCUSSION: This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection.
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spelling pubmed-74908752020-09-16 Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life Flierman, Isabelle van Rijn, Marjon de Meij, Marike Poels, Marjolein Niezink, Dorende M. Willems, Dick L. Buurman, Bianca M. Pilot Feasibility Stud Research BACKGROUND: A transitional care pathway (TCP) could improve care for older patients in the last months of life. However, barriers exist such as unidentified palliative care needs and suboptimal collaboration between care settings. The aim of this study was to determine the feasibility of a TCP, named PalliSupport, for older patients at the end of life, prior to a stepped-wedge randomized controlled trial. METHODS: A mixed-method feasibility study was conducted at one hospital with affiliated primary care. Patients were ≥ 60 years and acutely hospitalized. The intervention consisted of (1) training on early identification of the palliative phase and end of life conversations, (2) involvement of a transitional palliative care team during admission and post-discharge and (3) intensified collaboration between care settings. Outcomes were feasibility of recruitment, data collection, patient burden and protocol adherence. Experiences of 14 professionals were assessed through qualitative interviews. RESULTS: Only 16% of anticipated participants were included which resulted in difficulty assessing other feasibility criteria. The qualitative analysis identified misunderstandings about palliative care, uncertainty about professionals’ roles and difficulties in initiating end of life conversations as barriers. The training program was well received and professionals found the intensified collaboration beneficial for patient care. The patients that participated experienced low burden and data collection on primary outcomes and protocol adherence seems feasible. DISCUSSION: This study highlights the importance of performing a feasibility study prior to embarking on effectiveness studies. Moving forward, the PalliSupport care pathway will be adjusted to incorporate a more active recruitment approach, additional training on identification and palliative care, and further improvement on data collection. BioMed Central 2020-09-15 /pmc/articles/PMC7490875/ /pubmed/32944277 http://dx.doi.org/10.1186/s40814-020-00676-0 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Flierman, Isabelle
van Rijn, Marjon
de Meij, Marike
Poels, Marjolein
Niezink, Dorende M.
Willems, Dick L.
Buurman, Bianca M.
Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title_full Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title_fullStr Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title_full_unstemmed Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title_short Feasibility of the PalliSupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
title_sort feasibility of the pallisupport care pathway: results from a mixed-method study in acutely hospitalized older patients at the end of life
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490875/
https://www.ncbi.nlm.nih.gov/pubmed/32944277
http://dx.doi.org/10.1186/s40814-020-00676-0
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