Qualitative critical incident study of patients' experiences leading to emergency hospital admission with advanced respiratory illness.
BMJ Open
; 6(2): e009030, 2016 Feb 25.
Article
in En
| MEDLINE
| ID: mdl-26916687
ABSTRACT
OBJECTIVES:
The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital.SETTING:
3 UK hospitals located in different urban and rural settings.DESIGN:
Qualitative critical incident study.PARTICIPANTS:
24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients' care.RESULTS:
The analysis of patient, carer and professionals' interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms.CONCLUSIONS:
Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as 'inappropriate'.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Caregivers
/
Pulmonary Disease, Chronic Obstructive
/
Decision Making
/
Emergency Service, Hospital
/
Hospitalization
/
Lung Neoplasms
Type of study:
Clinical_trials
/
Prognostic_studies
/
Qualitative_research
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
BMJ Open
Year:
2016
Document type:
Article
Affiliation country:
United kingdom