Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study. (April 2019)

• Record Type: Journal Article
• Authors: McCaughan, Dorothy; Roman, Eve; Smith, Alexandra G.; Garry, Anne C.; Johnson, Miriam J.; Patmore, Russell D.; Howard, Martin R.; Howell, Debra A.
• Is Part Of: European journal of oncology nursing. Volume 39(2019)
• Page Start: 70
• Page End: 80
• Publication Date: 2019-04
• Subjects: Haematological malignancy -- Haematology nurse -- Place of care -- Place of death; Cancer -- Nursing -- Periodicals; Cancer -- Research -- Periodicals; Oncology -- Periodicals; Oncology Nursing -- Periodicals; Neoplasms -- nursing -- Periodicals; Cancer -- Soins infirmiers -- Périodiques; Cancer -- Recherche -- Périodiques; Cancérologie -- Périodiques; Verpleegkunde; Kanker; Cancer -- Nursing; Cancer -- Research; Oncology; Electronic journals; Periodicals; Electronic journals; 616.9940231
• DOI: 10.1016/j.ejon.2019.02.003
• Languages: English
• ISSNs: 1462-3889

Abstract

Abstract: Purpose: Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients' places of care and death. Method: Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach. Results: Five inter-related factors were identified as contributing to the likelihood of patients' receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home. Conclusions: Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred. Highlights: Patients with haematological malignancies are more likely to die in hospital than people with other cancers. No previous research has reported on UK haematology nurses' perspectives of their patients' place of care and place of death. Hospital deaths were largely attributed to disease characteristics, nature of treatment and difficulties with prognostication. However, other modifiable factors were also identified as barriers to death at home.