Abstract
Objectives:
To improve the ability of clinical staff to recognise end-of-life in hospital in-patients dying as a result of cancer and heart failure, and to generate new hypotheses for further research.
Methods:
This mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation.
The individual arms were (1) a retrospective cohort study of 102 cancer patients and 81 heart failure patients in an acute trust in the North of England, and (2) a semi-structured interview study of 19 healthcare professionals caring for the same patient groups.
Results:
The synthesis of findings demonstrated areas of agreement, partial agreement, silence and dissonance when comparing the cohort findings with the interview findings. Trajectories of change are identified as associated with poor prognosis in both approaches, but based on different parameters. Management of patients has a significant impact on decision-making. The decision process requires repeated, iterative assessments and may benefit from a multi-disciplinary approach. Uncertainty is a defining characteristic of the overall process, and objective parameters only have a limited role in predicting end of life.
Conclusions:
The role of uncertainty is important as a trigger for discussions and a defined stage in a patient’s illness journey. This is consistent with current approaches to recognising irreversible deterioration in those with serious illness. This study contributes ongoing evidence that these concepts are vital for decision-making.
To improve the ability of clinical staff to recognise end-of-life in hospital in-patients dying as a result of cancer and heart failure, and to generate new hypotheses for further research.
Methods:
This mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation.
The individual arms were (1) a retrospective cohort study of 102 cancer patients and 81 heart failure patients in an acute trust in the North of England, and (2) a semi-structured interview study of 19 healthcare professionals caring for the same patient groups.
Results:
The synthesis of findings demonstrated areas of agreement, partial agreement, silence and dissonance when comparing the cohort findings with the interview findings. Trajectories of change are identified as associated with poor prognosis in both approaches, but based on different parameters. Management of patients has a significant impact on decision-making. The decision process requires repeated, iterative assessments and may benefit from a multi-disciplinary approach. Uncertainty is a defining characteristic of the overall process, and objective parameters only have a limited role in predicting end of life.
Conclusions:
The role of uncertainty is important as a trigger for discussions and a defined stage in a patient’s illness journey. This is consistent with current approaches to recognising irreversible deterioration in those with serious illness. This study contributes ongoing evidence that these concepts are vital for decision-making.
| Original language | English |
|---|---|
| Journal | BMJ Supportive & Palliative Care |
| Early online date | 18 Oct 2018 |
| DOIs | |
| Publication status | Published - 2018 |
Keywords
- Cancer
- Heart Failure
- Dying
- Clinical Decisions
- Mixed methods
