title: Transitions to palliative care in acute hospitals in England: qualitative study.
abstract: OBJECTIVE
  To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  Secondary or primary care settings in two contrasting areas of England.
  
  
  METHODS
  58 health professionals involved in the provision of palliative care in secondary or primary care.
  
  
  RESULTS
  Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with "false hope" of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of "standing back" in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.
  
  
  CONCLUSIONS
  Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, New Zealand.
authors.forename: Merryn
authors.initials: M
authors.lastname: Gott
authors.forename: Christine
authors.initials: C
authors.lastname: Ingleton
authors.forename: Michael I
authors.initials: MI
authors.lastname: Bennett
authors.forename: Clare
authors.initials: C
authors.lastname: Gardiner