Improving regional care in the last year of life by setting up a pragmatic evidence-based Plan-Do-Study-Act cycle: results from a cross-sectional survey
Objectives To set up a pragmatic Plan-Do-Study-Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life. - Design Cross-sectional postbereavement survey. - Setting Regional health services research and development structure representing all healt...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
24 November 2020
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| In: |
BMJ open
Year: 2020, Volume: 10, Issue: 11 |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2019-035988 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/bmjopen-2019-035988 Resolving-System, kostenfrei: https://doi.org/10.1136/bmjopen-2019-035988 Verlag, lizenzpflichtig, Volltext: https://bmjopen.bmj.com/content/10/11/e035988 
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| Author Notes: | Raymond Voltz, Gloria Dust, Nicolas Schippel, Stefanie Hamacher, Sheila Payne, Nadine Scholten, Holger Pfaff, Christian Rietz, Julia Strupp, on behalf of The CoRe‑Net Co‑applicants: [Lena Ansmann und 7 weitere] |
| Summary: | Objectives To set up a pragmatic Plan-Do-Study-Act cycle by analysing patient experiences and determinants of satisfaction with care in the last year of life. - Design Cross-sectional postbereavement survey. - Setting Regional health services research and development structure representing all health and social care providers involved in the last year of life in Cologne, a city with 1 million inhabitants in Germany. - Participants 351 bereaved relatives of adult decedents, representative for age and gender, accidental and suspicious deaths excluded. - Results For the majority (89%) of patients, home was the main place of care during their last year of life. Nevertheless, 91% of patients had at least one hospital admission and 42% died in hospital. Only 60% of informants reported that the decedent had been told that the disease was leading to death. Hospital physicians broke the news most often (58%), with their communication style often (30%) being rated as ‘not sensitive’. Informants indicated highly positive experiences with care provided by hospices (89% ‘good’) and specialist palliative home care teams (87% ‘good’). This proportion dropped to 41% for acute care hospitals, this rating being determined by the feeling of not being treated with respect and dignity (OR=23.80, 95% CI 7.503 to 75.498) and the impression that hospitals did not work well together with other services (OR=8.37, 95% CI 2.141 to 32.71). - Conclusions Following those data, our regional priority for action now is improvement of care in acute hospitals, with two new projects starting, first, how to recognise and communicate a limited life span, and second, how to improve care during the dying phase. Results and further improvement projects will be discussed in a working group with the city of Cologne, and repeating this survey in 2 years will be able to measure regional achievements. - Trial registration number DRKS00011925. |
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| Item Description: | Gesehen am 16.02.2021 |
| Physical Description: | Online Resource |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2019-035988 |