Discharge Needs and Perceptions of Patients Receiving Palliative Care – A Qualitative Interview Study

Outcomes 1. Describe common themes elicited by patients and caregivers concerning the patient centered-ness of the hospital discharge process. 2. Integrate patient-centered priorities into the discharge process for patients with serious illness receiving palliative care services. Key Message Transitions of care are a high risk and stressful process, especially for patients with serious illness. We conducted qualitative interviews built around themes of patient-centeredness to elicit perspectives regarding the hospital discharge process from patients with serious illness and their caregivers. Prevalent themes include medication burden, unmet psychosocial and informational needs, and outpatient specialists as a transitional care resource. Introduction Transitions of care are a high risk process, with patients grappling with new changes in their medical care, bodies, and daily living. Patients with serious illness experience even more significant changes including changes in roles, a struggle for normality, and imbalance in everyday life.1 Our qualitative study aims to better understand the experience of the hospital discharge process from the perspective of patients with serious illness and their caregivers when leaving our academic tertiary care medical center. Methods We are conducting 25 semi-structured one-hour interviews with patients and/or caregivers who have been seen by our palliative care team and then discharged without hospice care or were readmitted within thirty days. Interview guide is designed to elicit perspectives concerning how patient-centered the discharge process is, including how holistic, individualized, respectful, and empowering it was, adapted from the framework developed by Burgers et al., as well as how successfully the patients reached their goals through the discharge process.2 The interview guide was piloted with two participants and was modified to add readmission-focused probing questions, and again after seven participants to include specific probing questions regarding the palliative care team's role in the discharge process. We are using an inductive content analysis approach using open coding to elicit themes regarding perceptions of the discharge process and perceived needs. Results Our initial themes include medication burden, psychosocial distress at discharge and after reaching home, mixed perceptions of individualized care and informational needs, and a strong relationship between involvement of outpatient specialists and patient outcomes. Conclusion Our patient-centered qualitative study has elicited patient and caregiver priorities regarding the hospital discharge process in a population seen by our palliative care team. Study findings will inform future interventions that address patient and caregiver perceived needs regarding discharge process improvement and prevention of readmission. Keywords Patient Outcomes; Models of Palliative Care Delivery