How do primary care clinicians approach hospital admission decisions for people in the final year of life? A systematic review and narrative synthesis

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)

Abstract

Background:
The final year of life is often associated with increasing health complexities and use of health services. This frequently includes admission to an acute hospital which may or may not convey overall benefit. This uncertainty makes decisions regarding admission complex for clinicians. There is evidence of much variation in approaches to admission.

Aims:
To explore how Primary Care clinicians approach hospitalisation decisions for people in the final year of life.

Design:
Systematic literature review and narrative synthesis.

Data sources:
We searched the following databases from inception to April 2023: CINAHL, Cochrane Library, Embase, MedLine, PsychInfo and Web of Science followed by reference and forward citation reviews of included records.

Results:
A total of 18 studies were included: 14 qualitative, 3 quantitative and 1 mixed methods study. As most of the results were qualitative, we performed a thematic analysis with narrative synthesis. Six key themes were identified: navigating the views of other stakeholders; clinician attributes; clinician interpretation of events; the perceived adequacy of the current setting and the alternatives; system factors and continuity of care.

Conclusion:
This review shows that a breadth of factors influence hospitalisation decisions. The views of other stakeholders take great importance but it is not clear how these views are, or should be, should be balanced. Clinician factors, such as experience with palliative care and clinical judgement, are also important. Future research should focus on how different aspects of the decision are balanced and to consider if, and how, this could be improved to optimise patient-centred outcomes and use of health resources.
Original languageEnglish
Pages (from-to)806-817
Number of pages12
JournalPalliative Medicine
Volume38
Issue number8
Early online date23 Aug 2024
DOIs
Publication statusE-pub ahead of print - 23 Aug 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Research Groups and Themes

  • Palliative and End of Life Care

Keywords

  • hospitalisation
  • Terminal care
  • clinical decision-making
  • primary health care

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