Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

• DOI: 10.3310/hsdr02170
• Publication Date: 2014-11-27T14:39:58Z
• Authors: Barbara Hanratty; Elizabeth Lowson; Gunn Grande; Sheila Payne; Julia Addington-Hall; Nicole Valtorta; Jane Seymour
• Keywords: End-of-Life Care

Background The end of life may be a time high service utilisation for older adults. Transitions between care settings occur frequently, but produce little improvement in symptom control or quality patients. Ensuring that patients experience co-ordinated care, and moves because individual needs rather than system imperatives, is crucial to patients’ well-being containing health-care costs. Objective aim this study was understand the experiences, influences consequences transitions adults at life. Three conditions were focus study, chosen represent differing disease trajectories. Setting England. Participants Thirty aged over 75 years, their last year life, diagnosed with heart failure, lung cancer stroke; 118 caregivers decedents 66–98 who had died cancer, stroke, chronic obstructive pulmonary selected other cancers; 43 providers commissioners services primary hospital, hospice, social ambulance services. Design methods This mixed-methods composed four parts: (1) in-depth interviews adults; (2) qualitative structured questionnaire bereaved carers adult decedents; (3) telephone using case scenarios derived from carers; (4) analysis linked Hospital Episode Statistics (HES) mortality data relating hospital admissions failure England 2001–10. Results common component end-of-life across all sets made up many shortly before death. Patients’ carers’ experiences disjointed which organisational processes prioritised needs. In cases, family carer co-ordinator provider home, excluded participation institutional lacking information support extend role confidence. general practitioner (GP) valued, central figure settings, though disciplines critical GPs’ expertise adherence guidelines. Out-of-hours homes identified by as contributors unnecessary transitions. Good relationships communication professionals different sectors recognised families one most important on rarely acknowledged staff. Conclusions Development shared understanding professional roles effective ways improving experiences. Patients manage aspects themselves. Identifying skills strengthen voices, particularly would welcomed reduce Why appear have changed little, despite implementation range relevant policies, an question has not been answered. Recommendations future research include relationship policy interventions identification harmonise voice, settings; influence interprofessional tensions care; development enhance Funding National Institute Health Research Services Delivery programme.