Abstract
Purpose
Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death.
Method
Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach.
Results
Five inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home.
Conclusions
Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.
Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death.
Method
Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach.
Results
Five inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home.
Conclusions
Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.
| Original language | English |
|---|---|
| Pages (from-to) | 70-80 |
| Number of pages | 11 |
| Journal | European journal of oncology nursing |
| Volume | 39 |
| Early online date | 7 Feb 2019 |
| DOIs | |
| Publication status | Published - Apr 2019 |
Bibliographical note
© 2019 The Authors.Funding Information:
This work was supported by the Marie Curie Research Grants Scheme (Grant Reference: C38860/A12554 ). HMRN is funded by Bloodwise (Grant Reference: 10042 ).
Funding Information:
This paper presents independent research supported by Marie Curie Cancer Care. The views expressed are those of the authors and not necessarily those of the funder.
Publisher Copyright:
© 2019 The Authors
Keywords
- Haematological malignancy
- Haematology nurse
- Place of care
- Place of death
- Attitude of Health Personnel
- Nursing Staff, Hospital/psychology
- Hematology
- Humans
- Palliative Care
- United Kingdom
- Perception
- Qualitative Research
- Terminal Care
- Hematologic Neoplasms/therapy
- Communication