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.

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.

Citation

McCaughan, D., Roman, E., Smith, A. G., Garry, A. C., Johnson, M. J., Patmore, R. D., Howard, M. R., & 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

• Journal Article Type: Article
• Acceptance Date: Feb 6, 2019
• Online Publication Date: Feb 7, 2019
• Publication Date: 2019-04
• Deposit Date: May 8, 2019
• Publicly Available Date: May 8, 2019
• 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
• DOI: https://doi.org/10.1016/j.ejon.2019.02.003
• Keywords: Haematological malignancy; Haematology nurse; Place of care; Place of death
• Public URL: https://hull-repository.worktribe.com/output/1759366
• 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/)
• Contract Date: May 8, 2019