A grounded theory study exploring healthcare professionals' experiences of decision making when managing the care of patients diagnosed with end stage heart failure

Higginbotham, K

Abstract

Background
End of life care has been a topic which has been debated, discussed and strategized over the last ten years as part of the government initiative to improve care for those patients with long term conditions requiring palliative and end of life care. (DH 2008, DH 2010). Studies show that despite these government and local recommendations’ heart failure patients are still not being given the opportunity to access individualised end of life care and the services they require to support themselves and their families at the end of life.

Aim
The aim of this study was to explore the decision-making process between healthcare professionals and patients in an acute medical setting when it came to making end of life decisions.

Method
A constructivist grounded theory was conducted over a 12-month period in a District General Hospital in the North West of England. A purposeful sample of 15 nurses, 11 doctors and 16 patients were recruited from the acute medical setting. Data was collected using semi structured interviews and focus groups. The interviews were recorded and transcribed and data was analysed using the constant comparison and QSR NVivo.

Findings
Four theoretical categories emerged from the data to explain how healthcare professionals and patients negotiated the process of decision making when considering end of life care. These four categories; signposting symptoms, organising care, being informed and recognising dying were found to revolve around a core category ‘vicious cycle of care’ which was fast paced, turbulent and time limited. This cycle was found to disable the process of decision making between the healthcare professional and patient resulting in missed opportunity for the patient to transition to palliative care.

Conclusion
The emerging theory ‘vicious cycle of care’ offers an explanation as to why decisions were not made by healthcare professionals to transition patients with end stage heart failure to palliative care. Further work needs to be undertaken with healthcare professionals and patients to map out a ‘cycle of care’ which identifies key stages in the terminal stage of heart failure and correctly signposts the patient to the right healthcare care professional for intervention. Further research is required with General Practitioners to further explore the barriers to providing end of life care for heart failure patients.

Citation

Higginbotham, K. (in press). A grounded theory study exploring healthcare professionals' experiences of decision making when managing the care of patients diagnosed with end stage heart failure. (Thesis). University of Salford

• Thesis Type: Thesis
• Acceptance Date: Sep 28, 2018
• Deposit Date: Oct 2, 2018
• Publicly Available Date: Nov 2, 2018