Predictors of a preference to return to hospital in palliative care: more questions than answers?

We are all aware of the evidence that shows the limitations of the acute hospital setting as a place for those nearing the end of their lives. Yet little is known about the benefits patients experience during their admission to hospital.  My PhD study of 116 hospital inpatients admitted with palliative care needs showed that although patients experience difficulties being in hospital, they also experience significant benefits. These benefits extend beyond the treatment received and include factors such as getting better, relief for family, feeling safe and getting help to manage at home.  In addition, despite experiencing difficulties being in hospital, almost all participants expressed a preference to come to hospital even if the care they received in hospital could have been provided at home: A qualitative study exploring the benefits of hospital admissions in palliative care

Traditional models of palliative care often fail to include the acute hospital setting as an appropriate or relevant place of care or place of death. In addition, studies have shown that the hospital is rarely chosen as a preferred place of care for those with a life limiting illness.  Interestingly, participants in my study showed a preference to return to hospital during a period of acute illness.

Identifying the factors that influence a preference to return to hospital is an important link to understanding the role of the acute hospital in palliative care. Further analysis of the findings from this study, showed that those living in more deprived areas experienced more benefit being in hospital, while younger people  and those from Asian or Pacific cultures  experienced more burden.  Feeling safe was an important benefit experienced by many participants in the study and was a significant predictor for a preference to return to hospital: Predictors of benefits, burdens and feeling safe

Like all good research, this study has left me with more questions than answers. For example, why do people feel safe in hospital and can this be replicated in other settings? How does living in deprivation influence peoples decision to be cared for in hospital? If home is cold and damp and there is not enough money for food and heating, being in hospital may be an attractive alternative. Finally, why do those from non-Western cultures experience more burden being in hospital? Does the Western dominated model of palliative care really meet the needs of everyone? Looks like I have the start of my post-doc work.

 

For more information please contact me j.robinson@auckland.ac.nz

Dr Jackie Robinson

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