From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study.
BACKGROUND
Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC.


METHODS
This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis.


RESULTS
The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures.


CONCLUSIONS
MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC.
Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands e.degraaf@umcutrecht.nl.
Everlien
E
de Graaf
Department of Pain and Supportive Care, Netherlands Cancer Institute Anthoni van Leeuwenhoek, Amsterdam, The Netherlands.
Merel
M
van Klinken
Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands e.degraaf@umcutrecht.nl.
Danielle
D
Zweers
Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands e.degraaf@umcutrecht.nl.
Saskia
S
Teunissen
D000368:Aged; D005260:Female; D017144:Focus Groups; D017051:Hospice Care / Q000379:methods* / Q000458:organization & administration / Q000523:psychology; D006738:Hospices; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011580:Psychological Techniques / Q000458:organization & administration; D036301:Qualitative Research; D011788:Quality of Life; D026443:Spiritual Therapies / Q000379:methods / Q000458:organization & administration
Hospice care; Quality of life; Symptoms and symptom management; interdisciplinary collaboration; multidimensional care