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Evid Based Nurs 12:128 doi:10.1136/ebn.12.4.128-a
  • Qualitative

Loss of continuity and lack of closure in therapeutic relationships were associated with feelings of abandonment at the transition to end of life care

Question

What are the perspectives of patients, their caregivers, physicians, and nurses on abandonment during transition to end of life care?

Design

Longitudinal qualitative study.

Setting

Seattle, Washington, USA.

Participants

Purposive sample of 31 physicians who spent ⩾50% of their time in clinical practice and could identify ⩾4 patients who had advanced cancer or severe chronic obstructive pulmonary disease and a life expectancy ⩽1 year. 55 eligible patients and their caregivers (n = 36) and nurses (n = 25) participated in the study.

Methods

Data were collected in semistructured interviews (220 h) at study entry, 4–6 months, and 12 months. Interviews were audiotaped and transcribed verbatim. Data were analysed thematically, using a limited application of grounded theory.

Main findings

2 themes described worries about or experiences of abandonment at transition to end of life care. (1) Loss of continuity before death. Patients and their families worried about loss of continuity of medical expertise: “Someone else would take over, who doesn’t have a lot of history with [the dying] person…I think that one could feel relatively abandoned.” One caregiver talked about transition to hospice: “…they’re just here to make you comfortable until you …