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Healthcare professionals' views on factors influencing end-of-life care in hospitals
  1. K Forbes,
  2. J Gibbins,
  3. M E Burcombe,
  4. S J Bloor,
  5. C M Reid and
  6. R C McCoubrie
  1. Department of Palliative Medicine, Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK

Abstract

Introduction and aims The majority of patients die in the acute setting, yet care delivered to the dying in hospitals is variable and the underlying reasons for this are not documented well. We aimed to explore healthcare professionals' views on the factors influencing good quality end-of-life care within an acute hospital Trust.

Methods Within a feasibility study examining the impact of a simple end-of-life care tool on the dying experience we carried out qualitative interviews with healthcare professionals caring for dying patients.

Results Five focus groups, nine face-to-face and two ‘think aloud’ interviews were analysed using the framework approach. The emerging themes were: difficulties in diagnosing dying (eg, senior doctors were required to validate the diagnosis when they might not know the patient well); role of the doctor (often task-based and directed by the nurses); changing role of nursing staff (leading end-of-life care); hospital culture (reluctance to withdraw active treatments; it was ‘brave’ to state a patient was dying); environment (appropriateness for dying patients) and the EOL tool validating care (nurses found the regular symptom scoring required by the tool helped them approach patients and families and give more appropriate care).

Conclusion This qualitative study has identified factors influencing care given to dying patients in an acute hospital setting. We suggest these factors need to be taken into account when trying to improve care for dying patients and in facilitating the use of EOL care pathways.

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