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Transitioning From Hospital to Palliative Care at Home: Patient and Caregiver Perceptions of Continuity of Care.

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CONTEXT Continuity of care is important at improving the patient experience and reducing unnecessary hospitalizations when transitioning across care settings, especially at the end of life. OBJECTIVE To explore patient… Click to show full abstract

CONTEXT Continuity of care is important at improving the patient experience and reducing unnecessary hospitalizations when transitioning across care settings, especially at the end of life. OBJECTIVE To explore patient and caregiver understanding and valuation of "continuity of care" while transitioning from an in-hospital to a home-based palliative care team. METHODS Longitudinal qualitative design using semi-structured interviews conducted with patients and their caregivers before and after transitioning from hospital to palliative care at home. Interviews were audio recorded and transcribed verbatim. Data were analyzed using thematic analysis within a post-positivist framework. Thirty-nine participants (18 patients, 7 caregivers and 7 patient-caregiver dyads) were recruited from two acute care hospitals wherein they received care from an inpatient palliative care consultation team and transitioned to home-based palliative care. RESULTS Patients had a mean age of 68, 60% were female and 60% had a diagnosis of cancer. Caregivers had a mean age of 62 and 50% were female. Participants perceived continuity of care to occur in three ways, depending on which stage they were at in their hospital-to-home transition. In hospital, continuity of care was experienced as consistency of information exchanged between providers. During the transition from hospital to home, continuity of care was experienced as consistency of treatments. When receiving home-based palliative care, continuity of care was experienced as having consistent providers. CONCLUSION Patients' and their caregivers' valuation of continuity of care was dependent on their stage of the hospital-to-home transition. Optimizing continuity of care requires an integrated network of providers with reliable information transfer and communication.

Keywords: home; continuity care; hospital; palliative care; care

Journal Title: Journal of pain and symptom management
Year Published: 2020

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