Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals
Abstract Background Patients who have received specialist intervention during periods of complex symptom and palliative care needs (e.g. pain crisis) may be discharged from specialist palliative care services to primary care. Despite such discharges being reasonably common, little is known about wha...
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BMC
2025-07-01
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| Series: | BMC Palliative Care |
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| Online Access: | https://doi.org/10.1186/s12904-025-01851-x |
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| author | Katharine Weetman Catherine Grimley Cara Bailey Celia J. Bernstein Jeremy Dale Aprella Fitch Sarah Mitchell Rumandeep Tiwana John I. MacArtney |
| author_facet | Katharine Weetman Catherine Grimley Cara Bailey Celia J. Bernstein Jeremy Dale Aprella Fitch Sarah Mitchell Rumandeep Tiwana John I. MacArtney |
| author_sort | Katharine Weetman |
| collection | DOAJ |
| description | Abstract Background Patients who have received specialist intervention during periods of complex symptom and palliative care needs (e.g. pain crisis) may be discharged from specialist palliative care services to primary care. Despite such discharges being reasonably common, little is known about what happens during this process. We sought to explore patient, carer and healthcare professional experiences, identifying ways to improve this crucial and time-sensitive part of the healthcare journey. Methods A qualitative interview study designed using an interpretive approach and reflexive thematic analysis methods. Sampling was purposive across six specialist palliative care sites (hospitals and hospices) and six general practices. Results A total of 38 participants took part in interviews:15 patients, 8 carers and 15 primary care professionals. Two overarching key themes were developed. The first described the multiple ways that ‘discharge’ was understood depending on the setting and circumstances of the patient. The second explored what was associated with better or worse transitions to primary care. Discharge communications that were accurate and complete were described as effective whereby written information reinforced verbal instructions and acted as a reminder. Participant suggestions for improving these discharge communications included: incorporating the patient’s palliative care preferences (e.g. advanced directives); offering letters to patients and, where appropriate, carers; providing post-discharge follow-up and contact details; ensuring medication instructions are accessible to patients and carers. Conclusions Current specialist palliative care discharge communications risk confusion, distress, and increased workload post-discharge. The study identified numerous suggestions professionals could take to improve this process. Trial registration Registered in ISRCTN Registry on 29.12.2023 ref: ISRCTN18098027. |
| format | Article |
| id | doaj-art-1c1511e8c78b4913b8bc203520df7b10 |
| institution | Kabale University |
| issn | 1472-684X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj-art-1c1511e8c78b4913b8bc203520df7b102025-08-20T03:43:34ZengBMCBMC Palliative Care1472-684X2025-07-0124111310.1186/s12904-025-01851-xImproving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionalsKatharine Weetman0Catherine Grimley1Cara Bailey2Celia J. Bernstein3Jeremy Dale4Aprella Fitch5Sarah Mitchell6Rumandeep Tiwana7John I. MacArtney8College of Medicine and Health, University of BirminghamWarwick Applied Health, Warwick Medical School, University of WarwickCollege of Medicine and Health, University of BirminghamWarwick Applied Health, Warwick Medical School, University of WarwickWarwick Applied Health, Warwick Medical School, University of WarwickPatient and Public Involvement Representative, University of BirminghamAcademic Unit of Palliative Care, University of LeedsCollege of Medicine and Health, University of BirminghamWarwick Applied Health, Warwick Medical School, University of WarwickAbstract Background Patients who have received specialist intervention during periods of complex symptom and palliative care needs (e.g. pain crisis) may be discharged from specialist palliative care services to primary care. Despite such discharges being reasonably common, little is known about what happens during this process. We sought to explore patient, carer and healthcare professional experiences, identifying ways to improve this crucial and time-sensitive part of the healthcare journey. Methods A qualitative interview study designed using an interpretive approach and reflexive thematic analysis methods. Sampling was purposive across six specialist palliative care sites (hospitals and hospices) and six general practices. Results A total of 38 participants took part in interviews:15 patients, 8 carers and 15 primary care professionals. Two overarching key themes were developed. The first described the multiple ways that ‘discharge’ was understood depending on the setting and circumstances of the patient. The second explored what was associated with better or worse transitions to primary care. Discharge communications that were accurate and complete were described as effective whereby written information reinforced verbal instructions and acted as a reminder. Participant suggestions for improving these discharge communications included: incorporating the patient’s palliative care preferences (e.g. advanced directives); offering letters to patients and, where appropriate, carers; providing post-discharge follow-up and contact details; ensuring medication instructions are accessible to patients and carers. Conclusions Current specialist palliative care discharge communications risk confusion, distress, and increased workload post-discharge. The study identified numerous suggestions professionals could take to improve this process. Trial registration Registered in ISRCTN Registry on 29.12.2023 ref: ISRCTN18098027.https://doi.org/10.1186/s12904-025-01851-xPalliative careHospice carePatient discharge summariesTransitional careCommunicationDischarge letters |
| spellingShingle | Katharine Weetman Catherine Grimley Cara Bailey Celia J. Bernstein Jeremy Dale Aprella Fitch Sarah Mitchell Rumandeep Tiwana John I. MacArtney Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals BMC Palliative Care Palliative care Hospice care Patient discharge summaries Transitional care Communication Discharge letters |
| title | Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals |
| title_full | Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals |
| title_fullStr | Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals |
| title_full_unstemmed | Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals |
| title_short | Improving specialist palliative care discharges from hospitals and hospices to community settings: a qualitative interview study of the communication experiences of patients, carers, and primary care professionals |
| title_sort | improving specialist palliative care discharges from hospitals and hospices to community settings a qualitative interview study of the communication experiences of patients carers and primary care professionals |
| topic | Palliative care Hospice care Patient discharge summaries Transitional care Communication Discharge letters |
| url | https://doi.org/10.1186/s12904-025-01851-x |
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