Dying in hospital in Germany – optimising care in the dying phase: study protocol for a multi-centre bottom-up intervention on ward level

BMC Palliative Care

Holger Schulz¹  Kerstin Kremeike²  Carolin Rosendahl²  Sukhvir Kaur²  Raymond Voltz²  Kathleen Boström²  Christin Leminski³  Holger Pfaff³  Kira Hower³  Martin Hellmich⁴  Nikolas Oubaid⁵  Anneke Ullrich⁵  Christina Plathe-Ignatz⁵  Karin Oechsle⁵ 

[1] Department of Medical Psychology, University Medical Center Hamburg-Eppendorf;Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne;Institute for Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Science and Faculty of Medicine, University of Cologne;Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne;Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf;

关键词: Dying phase;    Dying in hospital;    Bottom-up approach;    University hospitals;    Quality of care;    Focus groups;   

DOI  :  10.1186/s12904-022-00960-1

来源: DOAJ

【 摘 要 】

Abstract Background Hospitals are globally an important place of care for dying people and the most frequent place of death in Germany (47%), but at the same time, the least preferred one – for both patients and their relatives. Important indicators and outcome variables indexing quality of care in the dying phase are available, and various proposals to achieve corresponding quality objectives exist. However, they are not yet sufficiently adapted to the heterogeneous needs of individual hospital wards. Methods This multi-centre single-arm pre-post study aims at the development and implementation of context-specific measures in everyday clinical practice, followed by evaluating this approach. Therefore, (1) already existing measures regarding optimal care in the dying phase are identified applying a systematic literature review as well as an online survey and a symposium with experts. Supported by the thereby generated collection of measures, (2) a stratified sample of ten teams of different wards from two university hospitals select suitable measures and implement them in their everyday clinical practice. Circumstances of patients’ deaths on the selected wards are recorded twice, at baseline before application of the self-chosen measures and afterwards in a follow-up survey. Retrospective file analysis of deceased persons, quantitative staff surveys as well as qualitative multi-professional focus groups and interviews with relatives form the data basis of the pre-post evaluation. (3) Results are reviewed regarding their transferability to other hospitals and disseminated (inter-)nationally. Discussion Measures that are easy to implement and appropriate to the specific situation are supposed to significantly improve the quality of care during the dying phase in hospitals and contribute to the well-being of dying patients and their relatives. Successful implementation of those measures requires consideration of the individual conditions and needs of patients and their relatives—but also of the health professionals—on the different hospital wards. Therefore, a bottom-up approach, in which the ward-specific situation is first analysed in detail and then the staff itself selects and implements measures to improve care, appears most promising for optimising care in the dying phase in hospitals. Trial registration The study is registered in the German Clinical Trials Register ( DRKS00025405 ).

【 授权许可】

Unknown