What is the role of specialist palliative care in an acute hospital setting? A qualitative study exploring views of patients and carers

摘要

Background: Since the medical specialty of palliative medicine was recognized in 1988, the role of hospital specialist palliative care services has been developing, extending to patients who have a life-limiting illness but are not in the terminal phase. Aim: This qualitative study aims to explore patient and carer perspectives of the role of palliative care in the acute hospital setting, with patients not imminently dying. Design: Semi-structured interviews with 12 patients and 10 carers. Data were analysed using framework analysis. Setting/participants: Patients recruited were adults who had palliative care input for symptom control or psychological support and were discharged either to general ward care or to home. The family member/friend designated as their carer was also approached to take part. Results: All patients in this study were treated in an acute hospital, described as a bewildering and pressured environment of care. Initial perceptions of palliative care were varied, some interpreting referral as an indication that they were approaching the end of life. However, after palliative care input, patients and carers developed an understanding of their role which they saw as three-fold: physical symptom control, psychological support and a reliable liaison. The theme of cross-cutting interviews was that the palliative care team made time for patients, giving them a sense of value and worth. Feeling their care was a priority and being listened to made palliative care input effective. Conclusions: These findings will aid continuing development and evaluation of palliative care teams, in the domains of effectiveness as well as patient experience.