Abstract
BackgroundThe requirement to meet the palliative needs of acute hospital populations has grown in recent years. With increasing numbers of frail older people needing hospital care as a result of both malignant and non-malignant conditions, emphasis is being placed upon understanding the physical, psychological and social burdens experienced by patients. This study explores the extent of burden in two large UK hospitals, focusing upon those patients who meet palliative care criteria. Furthermore, the paper explores the use of palliative services and identifies the most significant clinical diagnostic and demographic factors which determine physical and psychological burden.MethodsTwo hospital surveys were undertaken to identify burden using the Sheffield Profile for Assessment and Referral to Care (SPARC). The Gold Standards Framework (GSF) is used to identify those patients meeting palliative care criteria. Participants were identified as being in-patients during a two-week data collection phase for each site. Data was gathered using face-to-face interviews or self-completion by patients or a proxy. Descriptive analyses highlight prevalence and use of palliative care provision. Binary logistic regression assesses clinical diagnostic predictor variables of physical and psychological burden.ResultsThe sample consisted of 514 patients and elevated physical, psychological and social burden is identified amongst those meeting palliative care criteria (n = 185). Tiredness (34.6%), pain (31.1%), weakness (28.8%) and psychological discomfort (low mood 19.9%; anxiety 16.1%) are noted as being prevalent. A small number of these participants accessed Specialist Palliative Care (8.2%). Dementia was identified as a predictor of physical (OR 3.94; p < .05) and psychological burden (OR 2.88; p < .05), being female was a predictor of psychological burden (OR 2.00; p < .05).ConclusionThe paper highlights elevated levels of burden experienced by patients with palliative care requirements. Moreover, the paper also indicates that a large proportion of such patients are not in receipt of palliative approaches to their care. Furthermore, the paper identifies that those with non-malignant illnesses, especially dementia, may experience high levels of physical and psychological burden.
Highlights
The requirement to meet the palliative needs of acute hospital populations has grown in recent years
We are beginning to understand the prevalence of palliative care needs within hospital sites [17] we know little about the specific burden associated with these patients across hospital populations
We do know that very few patients access Specialist Palliative Care (SPC) in hospital settings and we suspect that this is not indicative of need [17,18,19] and of those patients with palliative care needs little is known about which diagnostic and demographic factors might contribute to physical and psychological burden
Summary
The requirement to meet the palliative needs of acute hospital populations has grown in recent years. The number of people in the UK dying in a secondary care facility is set to rise by 20 per cent in the coming decades [1] This trend has not been lost on UK policy makers with the End of Life Care Strategy for England placing emphasis on the development of capacity to provide high quality palliative and supportive care for all patients, in all settings, including hospitals [2]. We do know that very few patients access Specialist Palliative Care (SPC) in hospital settings and we suspect that this is not indicative of need [17,18,19] and of those patients with palliative care needs little is known about which diagnostic and demographic factors might contribute to physical and psychological burden This latter point being of particular concern to those seeking to develop palliative care services for patients suffering from non-malignant diseases
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