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Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study

Published online by Cambridge University Press:  02 December 2021

Nicolas Schippel Open the ORCID record for Nicolas Schippel [Opens in a new window] ,
Gloria Dust ,
Christian von Reeken ,
Raymond Voltz ,
Julia Strupp  and
Christian Rietz
Nicolas Schippel*
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Koln, Germany
Gloria Dust
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Koln, Germany
Christian von Reeken
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Koln, Germany
Raymond Voltz
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Koln, Germany
Julia Strupp
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Koln, Germany
Christian Rietz
Affiliation:
Mixed-Methods Research, University of Education Heidelberg, Heidelberg, Germany
*
Author for correspondence: Nicolas Schippel, Wetzlarer Str. 10, 51105 Köln, Germany. E-mail: [email protected]
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Abstract

Objective

Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives.

Method

Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding.

Results

Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients’ preferences.

Significance of results

Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.

Keywords

End-of-life careHealth care transitionPatient preferencePatient transferPersonal communication
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 5 , October 2022 , pp. 637 - 645
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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