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PLoS One. 2015 Mar 10;10(3):e0118971. doi: 10.1371/journal.pone.0118971. eCollection 2015.

How could hospitalisations at the end of life have been avoided? A qualitative retrospective study of the perspectives of general practitioners, nurses and family carers

De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L.

This interview based study explored how hospitalisation at the end of life can be reduced. 26 GPs, 15 nurses and 18 family carers who were involved with 20 hospitalised and 10 non-hospitalised patients, were interviewed. The 5 key themes to help reduce hospitalisation at the end of life were: 1) marking the approach of death, and shifting the mind-set, which includes diagnosing dying and communicating this; 2) being able to provide acute treatment and care at home, 24 hours a day; 3) anticipatory discussions and interventions to deal with expected severe problems as people approached the end of life, including preferred priorities for care and place of death; 4) guiding and monitoring the patient and family in a holistic way through the illness trajectory, including detecting and responding to unexpected problems; 5) continuity of treatment and care at home, including medical and nursing home visits to support the patient and the family. These could help in avoiding hospitalisation at the end of life. The authors recommend that for all patients residing at home, GPs and community nurses work together as a team from the moment that it is marked that death is approaching up to the end of life.

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