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BMJ Support Palliat Care. 2018 Mar;8(1):78-86. doi: 10.1136/bmjspcare-2016-001289. Epub 2017 Jun 29.

Determinants of hospital death in haematological cancers: findings from a qualitative study.

Author information

1
Epidemiology & Cancer Statistics Group, Seebohm Rowntree Building, University of York, York, UK.
2
Department of Palliative Care, York Hospital, York, UK.
3
Centre for Health and Population Sciences, University of Hull, Hull, UK.
4
Queens Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, UK.
5
Department of Haematology, York Hospital, York, UK.

Abstract

OBJECTIVES:

Current UK health policy promotes enabling people to die in a place they choose, which for most is home. Despite this, patients with haematological malignancies (leukaemias, lymphomas and myeloma) are more likely to die in hospital than those with other cancers, and this is often considered a reflection of poor quality end-of-life care. This study aimed to explore the experiences of clinicians and relatives to determine why hospital deaths predominate in these diseases.

METHODS:

The study was set within the Haematological Malignancy Research Network (HMRN-www.hmrn.org), an ongoing population-based cohort that provides infrastructure for evidence-based research. Qualitative interviews were conducted with clinical staff in haematology, palliative care and general practice (n=45) and relatives of deceased HMRN patients (n=10). Data were analysed for thematic content and coding and classification was inductive. Interpretation involved seeking meaning, salience and connections within the data.

RESULTS:

Five themes were identified relating to: the characteristics and trajectory of haematological cancers, a mismatch between the expectations and reality of home death, preference for hospital death, barriers to home/hospice death and suggested changes to practice to support non-hospital death, when preferred.

CONCLUSIONS:

Hospital deaths were largely determined by the characteristics of haematological malignancies, which included uncertain trajectories, indistinct transitions and difficulties predicting prognosis and identifying if or when to withdraw treatment. Advance planning (where possible) and better communication between primary and secondary care may facilitate non-hospital death.

KEYWORDS:

Haematological malignancies; end of life.; hospital death; leukaemia; lymphoma; myeloma

PMID:
28663341
PMCID:
PMC5867428
DOI:
10.1136/bmjspcare-2016-001289
[Indexed for MEDLINE]
Free PMC Article

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