![]() These can be provided by a multidisciplinary health and social care team at in-patient, out-patient, day service, or home locations. Hospices deliver a range of free-at-the-point-of-access generalist and specialist palliative services that can provide pain and symptom control, end-of-life care, and/or respite services. Hospices in the UK are a heterogeneous group of independently funded charities with government funding averaging 35% (range 20–50%) of hospices expenditure. physical, psychological, social and spiritual) or how these needs are communicated to general practitioners. Furthermore, there is limited knowledge on what palliative care needs are associated with patients discharged from hospice-based care (e.g. Little is known about the content of communication at the time of discharge from hospice-based specialist palliative care services into community and primary care. National and international research indicates that communication issues are prevalent during care transitions, which can lead to adverse events such as readmissions and other consequences such as “inefficient use of time”. Efficient and effective cross-boundary communication is key, particularly as care transitions can risk patient safety. Hospice specialist care supports those with complex palliative needs, but there is often differences between how primary care (GPs) and Specialist Palliative Care understand what palliative care needs are complex and what services might best support a patient. Ĭo-ordinated and integrated, patient-centred palliative care, provided by primary and specialist palliative care within community and home settings are essential to a good death. Without reviewing and changing practices and policies, these disparities are likely to widen as the need for palliative care is increasing, especially in community-based settings. ![]() Evidence suggests that referrals to palliative care are skewed towards white cancer patients although less is known as to whether such disparities manifest in discharge practices. However, palliative care resources are not distributed equitably with inequalities of provision associated with ethnicity, diagnosis, and age. Specialist palliative care aims to provide care and support for people with complex palliative care needs. A patient-centred set of hospice-specific discharge letter principles could help improve future practice. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. The content and structure of discharge letters varied between hospices, although generally focused on physical needs. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”. The extent to which patients received a copy of their discharge letter varied. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Twenty-five staff took part in focus groups. We sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care. Thematic analysis was used to analyse the focus group transcripts. ![]() Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Discharge letters were extracted for key content information using a standardised form. ![]() MethodsĪn explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. ![]() Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges. It is essential that communication is effective if and when patients transition from hospice to community palliative care. The provision of palliative care is increasing, with many people dying in community-based settings. ![]()
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