"It's been quite a challenge": redesigning end-of-life care in acute hospitals.
OBJECTIVE
This paper reports the findings of an interview-based study undertaken to investigate the introduction of end-of-life (EoL) care pathways in three acute trusts, as part of a larger project examining service redesign. The aim was to examine the barriers to and facilitators of change.


METHODS
Twenty-one in-depth qualitative interviews were conducted with staff working in three National Health Service (NHS) acute hospital trusts. These staff members were involved in end-of-life care, and their accounts were analyzed to identify the key issues when introducing service changes in these settings.


RESULTS
Thematic analysis revealed five major themes-two of which, leadership and facilitation, and education and training, indicate what needs to be in place if end-of-life care pathways are to be adopted by staff. However, the remaining three themes of difficult conversations, diagnosing dying, and communication across boundaries highlight particular areas of practice and organization that need to be addressed before end-of-life care in hospitals can be improved.


CONCLUSIONS
Organization of end-of-life care in acute hospitals is challenging, and care pathways provide a degree of guidance as to how services can be delivered. However, even when there is effective leadership at all levels of an organization and an extensive program of education for all staff support the use of care pathways, significant barriers to their introduction remain. These include staff anxieties concerning diagnosing dying and discussing dying and end-of-life care planning with patients and their families. It is hoped these findings can inform the development of the proposed new care plans which are set to replace end of life care pathways in England.
Department of Nursing,School of Health and Population Sciences,University of Birmingham,Edgbaston,Birmingham,United Kingdom.
Alistair
A
Hewison
Department of Nursing,School of Health and Population Sciences,University of Birmingham,Edgbaston,Birmingham,United Kingdom.
Laura
L
Lord
Department of Nursing,School of Health and Population Sciences,University of Birmingham,Edgbaston,Birmingham,United Kingdom.
Cara
C
Bailey
D001291:Attitude of Health Personnel; D004739:England; D006301:Health Services Needs and Demand; D006769:Hospitals, General / Q000379:methods* / Q000592:standards; D006801:Humans; D036301:Qualitative Research; D013727:Terminal Care / Q000379:methods* / Q000592:standards
End of life; Hospitals; Qualitative methods; Staff experience