Abstract
Background: Communication between hospital clinicians and patients in the palliative phase about their values, wishes and needs is essential to achieve appropriate palliative care.
Aim: To explore the barriers and facilitators concerning communication with patients in de palliative phase about their values, wishes and needs as experienced or indicated by hospital clinicians.
Methods: A mixed-methods systematic review was conducted following the PALETTE-method and PRISMA-guidelines. Eight databases were searched without time-restrictions. Original articles were eligible if they focussed on 1) hospital clinicians and 2) barriers and facilitators to communication about values, wishes and needs of adult patients in the palliative phase. Two researchers independently selected articles and appraised the quality. Findings were synthesized using a convergent integrated approach following the Joanna Briggs Institute’s guidelines.
Results:
2259 articles were identified. Preliminary results from the studies selected to date (N=23) show that the barriers and facilitators can be expressed in four synthesized findings:
1) Patient characteristics: lack of understanding of the disease and treatment or difficulty accepting the prognosis;
2) Clinician characteristics: lack of competence or experience;
3) Patient’s social context: dealing with conflicting views or family tensions;
4) Organizational factors: a lack of time and privacy or unclear roles.
Most studies focussed on decision making about medical treatment in the physical dimension, often near the end of life.
Conclusions: Hospital clinicians indicate several barriers and facilitators to discuss the values, wishes and needs with patients in the palliative phase. A structured approach to explore and monitor the patients’ values, wishes and needs in all four dimensions and throughout the entire palliative phase would be beneficial to ameliorate appropriate palliative care.
Funded by the Jonker-Driessen Foundation
Aim: To explore the barriers and facilitators concerning communication with patients in de palliative phase about their values, wishes and needs as experienced or indicated by hospital clinicians.
Methods: A mixed-methods systematic review was conducted following the PALETTE-method and PRISMA-guidelines. Eight databases were searched without time-restrictions. Original articles were eligible if they focussed on 1) hospital clinicians and 2) barriers and facilitators to communication about values, wishes and needs of adult patients in the palliative phase. Two researchers independently selected articles and appraised the quality. Findings were synthesized using a convergent integrated approach following the Joanna Briggs Institute’s guidelines.
Results:
2259 articles were identified. Preliminary results from the studies selected to date (N=23) show that the barriers and facilitators can be expressed in four synthesized findings:
1) Patient characteristics: lack of understanding of the disease and treatment or difficulty accepting the prognosis;
2) Clinician characteristics: lack of competence or experience;
3) Patient’s social context: dealing with conflicting views or family tensions;
4) Organizational factors: a lack of time and privacy or unclear roles.
Most studies focussed on decision making about medical treatment in the physical dimension, often near the end of life.
Conclusions: Hospital clinicians indicate several barriers and facilitators to discuss the values, wishes and needs with patients in the palliative phase. A structured approach to explore and monitor the patients’ values, wishes and needs in all four dimensions and throughout the entire palliative phase would be beneficial to ameliorate appropriate palliative care.
Funded by the Jonker-Driessen Foundation
| Original language | English |
|---|---|
| Pages (from-to) | 75 |
| Journal | Palliative Medicine |
| Volume | 36 |
| Issue number | S1 |
| DOIs | |
| Publication status | Published - 2022 |