Interactive Studies Unit, Institute of Clinical Sciences, Birmingham Medical School, University of Birmingham, Birmingham, B15 2TT, UK.
Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK.
BMC Palliat Care. 2022 Sep 6;21(1):155. doi: 10.1186/s12904-022-01038-8.
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.
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.
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".
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.
姑息治疗的提供正在增加，许多人在社区环境中死亡。如果和当患者从临终关怀过渡到社区姑息治疗时，有效的沟通是至关重要的。过去的研究表明，在医院出院期间存在沟通问题，但对临终关怀出院的情况知之甚少。
本研究采用解释性顺序混合方法，包括回顾性审查临终关怀出院信，然后进行临终关怀焦点小组，以探讨出院患者姑息治疗需求沟通的模式，并描述这些患者为何出院。使用标准化表格提取出院信中的关键内容信息。然后使用称为语料库语言学的语言方法检查信件中的语言模式。使用主题分析对焦点小组记录进行分析。研究结果进行三角剖分，以从临终关怀护理的角度发展对出院沟通的解释性理解。
我们从英国五家临终关怀机构中抽取了 250 封出院信，这些患者已被转至初级保健机构。25 名工作人员参加了焦点小组。从信件中提取的主要出院原因是症状“已管理/已解决”（75.2%），和/或“患者希望死亡/在家中接受护理”（37.2%）。大多数患者的信件中有某种形式的身体需求记录（98.4%），但很少记录精神需求（2.4%）。心理/情绪需求和社会需求分别在 46.4%和 35.6%的信件中有记录。出院信中有时会出现歧义，即“谁”将跟进“什么”，以及描述的患者需求是在社区环境中已解决还是仍在进行中。患者收到出院信副本的程度各不相同。焦点小组传达了对什么构成“复杂性”和“复杂疼痛”缺乏共识。
尽管总体上侧重于身体需求，但各临终关怀机构之间的出院信内容和结构有所不同。我们的研究提供了对从临终关怀机构出院的患者相关模式的深入了解，以及如何改进这方面的政策和指导，例如增加与患者共享信件的一致性。一套以患者为中心的临终关怀特定出院信原则可以帮助改善未来的实践。
