Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study

Katharine Weetman*, Jeremy Dale, Sarah J. Mitchell, Claire Ferguson, Anne Finucane, Peter Buckle, Elizabeth Arnold, Gemma Clarke, Despoina-Elvira Karakitsiou, Tracey McConnell, Nikhil Sanyal, Anna Schuberth, Georgia Tindle, Rachel Perry, Bhajneek Grewal, Katarzyna Patynowska, John MacArtney

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: The provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges.

Methods: An explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care.

Results: We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”.

Conclusions: The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice.
Original languageEnglish
Article number155
Number of pages15
JournalBMC Palliative Care
Volume21
Issue number1
DOIs
Publication statusPublished - 6 Sept 2022

Bibliographical note

Funding Information:
This work was supported by Marie Curie, grant (ref. MCSGS-21-502). The funds for open access publication of this manuscript were provided by Marie Curie. JM, AF, GC and TM Fellowships and time on this study were funded by Marie Curie.

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Palliative care
  • Hospice care
  • Patient discharge summaries
  • Transitional care
  • Communication

ASJC Scopus subject areas

  • General Medicine

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