The SHIPS Study: SHaring Information at the Primary/Secondary care interface for patients with a poor prognosis

Problem

Up to one in three people die in the 12 months following an emergency hospital admission and this is an opportunity for hospital clinicians to identify patients with a poor prognosis and share this with General Practitioners (GPs). There is a lack of consensus about this communication and a need to synthesise the evidence in order to improve continuity of care.

Aim

To investigate the communication of poor prognosis from secondary care to primary care at hospital discharge.

Approach

The study will be conducted in two phases:

1. A systematic review with narrative synthesis of evidence on sharing information about patients with a poor prognosis between secondary care and primary care. The review will address the following questions: How is poor prognosis communicated? What are the facilitators of, and barriers to, this communication? What evidence exists of the impact of this communication on patient care? How acceptable and useful is this communication to patients, family/carers and clinicians?

2. A focused ethnography to explore the communication of poor prognosis to GPs on discharge from hospital. Data collection will take place in four hospital trusts and linked GP surgeries in two regions in England. Non-participant observation will be conducted on 12 hospital wards across the four trusts, to explore decision-making around the sharing of prognostic information with GPs at discharge and the facilitators of, and barriers to, sharing this information. Anonymised examples of written information sharing will be collated alongside documentation of telephone calls with GPs in the medical records. In-depth interviews will be conducted with purposive samples of hospital clinicians, GPs, patients and carers about the process of information-sharing and their views of this.

Findings

The results of the phase one systematic review will be available for presentation at the time of the conference.

Consequences

A lack of communication from secondary care in relation to prognosis is a potential barrier to the initiation, or continuation, of Advance Care Planning conversations by GPs. Addressing these GP information needs would facilitate this process and improve care at the end of life.