Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey
Objectives To set up a pragmatic Plan–Do–Study–Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life.Design Cross-sectional postbereavement survey.Setting Regional health services research and development structure representing all health and...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e035988.full |
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| author | Lena Ansmann Holger Pfaff Ingrid Schubert Ludwig Kuntz Stephanie Stock Sheila Payne Nadine Scholten Ute Karbach Stefanie Hamacher Raymond Voltz Christian Albus Frank Jessen Christian Rietz Frank Schulz-Nieswandt Julia Strupp Gloria Dust Nicolas Schippel |
| author_facet | Lena Ansmann Holger Pfaff Ingrid Schubert Ludwig Kuntz Stephanie Stock Sheila Payne Nadine Scholten Ute Karbach Stefanie Hamacher Raymond Voltz Christian Albus Frank Jessen Christian Rietz Frank Schulz-Nieswandt Julia Strupp Gloria Dust Nicolas Schippel |
| author_sort | Lena Ansmann |
| collection | DOAJ |
| description | Objectives To set up a pragmatic Plan–Do–Study–Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life.Design Cross-sectional postbereavement survey.Setting Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany.Participants 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded.Results For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as ‘not sensitive’. Informants indicated highly positive experiences with care provided by hospices (89% ‘good’) and specialist palliative home care teams (87% ‘good’). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71).Conclusions Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements.Trial registration number DRKS00011925. |
| format | Article |
| id | doaj-art-05e5cffe4f8a48298992ddb6978b2733 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-05e5cffe4f8a48298992ddb6978b27332025-08-20T02:33:05ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2019-035988Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional surveyLena Ansmann0Holger Pfaff1Ingrid SchubertLudwig Kuntz2Stephanie Stock3Sheila Payne4Nadine Scholten5Ute Karbach6Stefanie Hamacher7Raymond Voltz8Christian AlbusFrank Jessen9Christian Rietz10Frank Schulz-NieswandtJulia Strupp11Gloria Dust12Nicolas Schippel13Department of Organizational Health Services Research, University of Oldenburg, Oldenburg, GermanyFaculty of Human Sciences and Faculty of Medicine, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, GermanyDepartment of Business Administration and Healthcare Management, University of Cologne, Cologne, GermanyInstitute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, GermanyInternational Observatory on End of Life Care, University of Lancaster, Lancaster, UKUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, GermanyDepartment of Rehabilitation Sociology, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, GermanyInstitute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany1 Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, GermanyDepartment of Psychiatry and Psychotherapy, University of Bonn, Bonn, GermanyFaculty of Educational and Social Sciences, Department of Educational Science, Heidelberg University of Education, Heidelberg, GermanyDepartment of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, GermanyDepartment of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, GermanyFaculty of Human Sciences and Faculty of Medicine, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Cologne, GermanyObjectives To set up a pragmatic Plan–Do–Study–Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life.Design Cross-sectional postbereavement survey.Setting Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany.Participants 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded.Results For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as ‘not sensitive’. Informants indicated highly positive experiences with care provided by hospices (89% ‘good’) and specialist palliative home care teams (87% ‘good’). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71).Conclusions Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements.Trial registration number DRKS00011925.https://bmjopen.bmj.com/content/10/11/e035988.full |
| spellingShingle | Lena Ansmann Holger Pfaff Ingrid Schubert Ludwig Kuntz Stephanie Stock Sheila Payne Nadine Scholten Ute Karbach Stefanie Hamacher Raymond Voltz Christian Albus Frank Jessen Christian Rietz Frank Schulz-Nieswandt Julia Strupp Gloria Dust Nicolas Schippel Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey BMJ Open |
| title | Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey |
| title_full | Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey |
| title_fullStr | Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey |
| title_full_unstemmed | Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey |
| title_short | Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan–Do–Study–Act cycle: results from a cross-sectional survey |
| title_sort | improving regional care in the last year of life by setting up a pragmatic evidence based plan do study act cycle results from a cross sectional survey |
| url | https://bmjopen.bmj.com/content/10/11/e035988.full |
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