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

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

Authors

Dorothy McCaughan

Eve Roman

Alexandra G. Smith

Anne Garry

Russell Patmore

Martin Howard

Debra A. Howell



Abstract

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. 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.

Citation

McCaughan, D., Roman, E., Smith, A. G., Garry, A., Johnson, M., Patmore, R., …Howell, D. A. (2018). Determinants of hospital death in haematological cancers: findings from a qualitative study. BMJ supportive & palliative care, 8(1), 78-86. https://doi.org/10.1136/bmjspcare-2016-001289

Acceptance Date May 20, 2017
Online Publication Date Jun 29, 2017
Publication Date 2018-03
Deposit Date Jul 10, 2017
Publicly Available Date Mar 7, 2018
Journal BMJ supportive & palliative care
Print ISSN 2045-435X
Electronic ISSN 2045-4368
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 1
Pages 78-86
DOI https://doi.org/10.1136/bmjspcare-2016-001289
Keywords Haematological malignancies, Leukaemia, Lymphoma, Myeloma, Hospital death, End of life care
Public URL https://hull-repository.worktribe.com/output/453451
Publisher URL http://spcare.bmj.com/content/early/2017/06/29/bmjspcare-2016-001289
Copyright Statement This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Additional Information Copy of article published in: BMJ supportive & palliative care, 2017

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https://creativecommons.org/licenses/by/4.0/

Copyright Statement
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/





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