Article Text
Abstract
Objectives Accurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question (SQ) to identify those patients. Little is known about physicians’ views on identifying and disclosing the last phase of life of patients with different illness trajectories.
Methods Data from two focus groups were analysed using thematic analysis with a phenomenological approach.
Results Fifteen medical specialists and general practitioners participated. Participants thought prediction of patients’ last phase of life, i.e. expected death within 1 year, is important. They seemed to find that prediction is more difficult in patients with advanced organ failure compared with cancer. The SQ was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradually disclosing the last phase. Participants’ reluctance to such disclosure was related to uncertainty around prognostication, concerns about depriving patients of hope, affecting the physician–patient relationship, or a lack of time or availability of palliative care services.
Conclusions Physicians consider the assessment of patients’ last phase of life important and support use of the SQ in patients with different illness trajectories. However, barriers in disclosing expected death are prognostic uncertainty, possible deprivation of hope, physician–patient relationship, and lack of time or palliative care services. Future studies should examine patients’ preferences for those discussions.
- cancer
- chronic obstructive pulmonary disease
- communication
- prognosis
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Footnotes
Presented at An abstract based on these findings was presented at the European Association of Palliative Care 2018 Symposium in Bern, 23-26 May 2018.
Contributors AvdH, CCDvdR and CO designed the study. CCDvdR moderated the focus groups. CO and IvB coded and analysed the data. AvdH and CCDvdR checked the coding and data analysis. CO wrote the first draft of the paper. All authors revised the paper and approved the final version.
Funding This study was funded by The Netherlands Organization for Health Research and Development (grant number 844001209).
Competing interests CCDvdR reports grants from The Netherlands Organization for Health Research and Development, during the conduct of the study.
Patient consent for publication Not required.
Ethics approval Under Dutch Law, studies not involving patients are waived from review by a research ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The focus group transcripts in Dutch that were analysed in this study are available from the corresponding author on reasonable request.