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Haematology nurses' perspectives of their patients' places of care and death: a UK qualitative interview study

McCaughan, Dorothy; Roman, Eve; Smith, Alexandra G.; Garry, Anne C.; Johnson, Miriam J.; Patmore, Russell D.; Howard, Martin R.; Howell, Debra A.

Authors

Dorothy McCaughan

Eve Roman

Alexandra G. Smith

Anne C. Garry

Russell D. Patmore

Martin R. Howard

Debra A. Howell



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.

Journal Article Type Article
Publication Date 2019-04
Journal European Journal of Oncology Nursing
Print ISSN 1462-3889
Electronic ISSN 1532-2122
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 39
Pages 70-80
APA6 Citation McCaughan, D., Roman, E., Smith, A. G., Garry, A. C., Johnson, M. J., Patmore, R. D., …Howell, D. A. (2019). Haematology nurses' perspectives of their patients' places of care and death: a UK qualitative interview study. European journal of oncology nursing, 39, 70-80. https://doi.org/10.1016/j.ejon.2019.02.003
DOI https://doi.org/10.1016/j.ejon.2019.02.003
Keywords Haematological malignancy; Haematology nurse; Place of care; Place of death
Publisher URL https://www.sciencedirect.com/science/article/pii/S1462388919300183?via%3Dihub
Additional Information ©2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/)

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Copyright Statement
©2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/





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