Circumstances of hospital admissions in palliative care

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On average people will experience 2.28 hospital admissions in the last year of life with the likelihood of a hospital admission increasing in the last two weeks of life. Reducing hospital admissions has become a focus for high income countries as they work to manage the financial implications of an ageing population. However, studies exploring reasons for admisson have largely focused on presenting physical symptoms, some of which, it has been suggested, could be anticipated and managed outside the hospital setting with support from community palliative care services. Yet, the circumstances by which patients with palliative care needs are admitted to hospital remain poorly understood.

This article draws on data collected using a cross sectional survey of patients admitted to an acute hospital with palliative care needs. Continuing on from my previous article which describes the predictors of patient related benefit and burden in relation to hospital admissions in palliative care  https://www.ncbi.nlm.nih.gov/pubmed/28952886 this article, recently published in Palliative Medicine, explores the circumstances of hospital admissions in palliative care http://journals.sagepub.com/doi/abs/10.1177/0269216318756221

Unsurprisingly this study found that those with a non-malignant diagnosis were less likely to have hospice involved prior to admission.  When considering the role of community services, few participants recognized community services such as their general practitioner or hospice team to have a role in enabling them to remain at home.  This finding is particularly concerning given the increasing assumption by hospital leaders and policy makers that increasing community supports will result in more people being able to be cared for and die at home.  When exploring people’s priorities on the day of admission, participants with cancer placed a significantly higher priority on receiving information about their illness and receiving tests and investigations compared to those with a non-malignant illness.  This finding suggests, that those with cancer may require a different level of information and explanation in response to changing symptoms and/or deterioration in health status.

This study has demonstrated the complexity of hospital admissions in palliative care. Further research is needed to explore patient perceptions of care at home and the role of community services to enable them to remain at home.  Understanding the motivation to come to hospital in the context of an incurable illness and limited treatment options will help to inform the development of services that can enable better care at home whilst enabling hospitals to focus on providing care that can only be provided in this setting.

 

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