- Author
-
I. Flierman
- Title
- Timely palliative care for older patients
- Subtitle
- From early identification to better transmural collaboration
- Supervisors
-
D.L. Willems
B.M. Buurman-van Es - Award date
- 22 June 2021
- Number of pages
- 225
- ISBN
- 9789083102733
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
The overall aim of this thesis was to provide scientific evidence concerning timely identification of the palliative phase, collaboration between hospitals and home, and transmural palliative care, needed for the development of the building blocks for the PalliSupport transmural care pathway intervention. An intervention aimed at improving palliative care for older patients, lowering unwanted hospital admissions and increasing the number of patients dying at their preferred place.
In the first part of this thesis we looked at how hospital-based professionals identify the palliative phase and if identification instruments could help. We found that identification is a relatively unstructured process and that difficulties occur because of a persistent focus on treatment, the unpredictability of diseases, and obstacles in communication with patients and in the collaboration with other professionals. We further found that identification instruments do not have sufficient prognostic accuracy to be used as a method to determine one year mortality in acutely hospitalized older patients.
In part II of this thesis we focused on transmural collaboration in palliative care. We found that currently handover between hospital and home is hindered by lack of identification, focus on solely physical aspects, lack of direct communication, and uncertainty in responsibilities. A literature study found that transmural team-based palliative care interventions can reduce the number of hospital admission and improve the number of patients dying at their preferred place. Furthermore, we performed a feasibility study of the PalliSupport transmural care pathway intervention which led to the adjustment of the protocol prior to the effectiveness trial. - Persistent Identifier
- https://hdl.handle.net/11245.1/ba3d7d6d-02f4-45ba-8726-a58195079151
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction
Chapter 2: How do hospital-based nurses and physicians identify the palliative phase in their patients and what difficulties exist? A qualitative interview study
Chapter 3: Usability of the Surprise Question by nurses to identify 12-month mortality in hospitalized older patients: A prospective cohort study
Chapter 4: Prognostic accuracy of the Surprise Question, SPICT, GSFPIG and PPS in determining one-year mortality in acutely hospitalized older patients
Chapter 5: Healthcare providers’ views on the transition between hospital and primary care in patients in the palliative phase: A qualitative description study
Chapter 6: Effectiveness of transmural team-based palliative care in prevention of hospitalizations in patients at the end-oflife. A systematic review and meta-analysis
Chapter 7: Feasibility of the PalliSupport care pathway; Results from a mixed-method study in acutely hospitalized older patients at the end of life
Chapter 8: Effectiveness of transmural team-based palliative care for older patients at the end of life, PalliSupport: Protocol of a stepped-wedge cluster randomized trial
Chapter 9: General discussion
Summary; Nederlandse samenvatting
Portfolio; Scientific publications; Dankwoord; Curriculum vitae
- Supplementary materials
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