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How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist?: A qualitative interview study

BMC Palliative Care Jul 15, 2019

Flierman I, et al. – Researchers conducted semi-structured interviews with 10 nurses and 18 physicians working at y hospitals in the Netherlands to assess how hospital-based nurses and physicians define the palliative phase, how they identify the palliative phase, and what difficulties they face. Data were evaluated via thematic analysis. In all, nurses and physicians felt anxious about how to define the palliative phase and distinguish between acute and extended phases. Great variation existed in what life expectancy was connected to each phase. Prognostication, treatment trade-off, evaluation of patients’ preferences and needs, and interprofessional collaboration were all reported as different ways to identify the palliative phase. Professionals based prognostication on their experience, but also searched for clinical signs. When benefits of treatment no longer outweigh the negatives, this was considered to be an identification point. According to interview findings, starting a conversation on a patients’ palliative care needs was considered to be difficult. In light of this, some respondents tended to wait for patients to vocalize their own preferences. Furthermore, many professionals reported relying on interprofessional collaboration for identification; however, there was some uncertainty about responsibilities. Difficulties in identification transpired because of varying definitions, unpredictability of non-oncological diseases, focus on treatment, and difficulties in communication and collaboration. Overall, findings provided insight into the challenges and complexities of hospital-based professionals’ experiences with respect to the timely recognition of patients with palliative care needs.

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