Vermijden van ziekenhuisopname aan het levenseinde*

Objective

To describe how hospitalisation at the end of life can be avoided, from the perspective of general practitioners (GPs), nurses and family carers.

Design

Qualitative study with open interviews.

Method

We interviewed 26 GPs, 15 nurses and 18 family carers of 30 patients who had died non-suddenly. 20 of the patients had been hospitalised in the last three months of life; 10 had not been hospitalised.

Results

Analysing the interviews, we identified five key strategies that could help to avoid hospitalisation at the end of life. These were: (a) marking the approach of death and shifting the mindset regarding the care required; (b) providing acute treatment and care at the end of life; (c) anticipatory discussions and interventions; (d) guiding and monitoring during the illness trajectory; and (e) continuity of care and treatment at home. The in-depth interviews indicated that it is necessary for these five strategies to be applied in an interrelated way by a team of GPs and nurses.

Conclusion

We identified five interrelated strategies that can help to avoid hospitalisation at the end of life. In the case of patients receiving end-of-life care at home, we recommend that GPs and nurses work together from the moment when the approach of death is marked.

Conflict of interest and financial support: this study was supported by a grant from ZonMw (no 11510005).