Person-centered shift handovers in oncological inpatient care

Abstract

Surveys show that patients are not sufficiently involved in decisions and planning regarding their own care, and patients have reported unfulfilled information needs in inpatient settings. To develop inpatient cancer care towards more person-centeredness, practices and ethics need to change. The nurse shift handovers have traditionally been performed secluded from patients, and without given structure. These handovers have been identified as opportunities for patient involvement, and different models of bedside handovers have been implemented and evaluated with varying results. Person-centered handovers (PCH) were developed in an attempt of combining the ethics and core components of person-centered care, and the practical task of performing the shift handover at bedside. PCH were implemented stepwise at three oncological inpatient wards at the Department of Oncology, Karolinska University Hospital. PCH include the patient, the on-coming nurse, the off-going nurse, and sometimes patients’ visitors and nurse assistants. The main intentions with PCH were to promote structured, safe, and efficient handovers, provide an opportunity for patients and nurses to create a joint plan for the care, and to promote information exchange between nurses and patients. The general aim of this thesis was to identify and describe consequences of introducing PCH in oncological inpatient care. Specific aims included to investigate whether PCH could influence patient satisfaction, patients’ perceptions of information provision, health related quality of life (HRQoL), and to describe nurses’ perceptions of working with PCH.

The thesis is comprised of three studies, presented in four different scientific papers. The first study (Paper I and IV) was cross-sectional with two points of measurement. Two of the inpatient wards served as a comparison group and practiced standard handovers during the study period, while PCH was implemented at the third ward after the first point of measurement. Adult patients cared for at the wards assessed their satisfaction with care by responding to the EORTC IN-PATSAT32 questionnaire, HRQoL with EORTC QLQ-C30, and perceptions of information with the EORTC QLQ-INFO25 module. Differences between the Comparison wards and the Intervention ward were analyzed with linear regression. Two years after the first study, a second data collection was carried out at the previous Comparison wards where PCH had been implemented about two years earlier, Paper III. Patients assessed their satisfaction with care and their perceptions of individualized care. Comparisons on patient satisfaction were made with data from the first study, and were performed with linear regression analysis. In Paper II, registered nurses working at the inpatient wards were interviewed about their perceptions of PCH. The data were analyzed with inductive qualitative content analysis. In Paper I and IV, 325 patients (57 %) participated. Regarding patient satisfaction, no statistically significant differences were observed between the ward that employed PCH and those that used standard handover, apart from one exception. Patients’ satisfaction on “Information exchange between caregivers” was statistically significantly at the intervention ward than at the comparison wards. PCH were not related to patients’ HRQoL or perceptions of information. In Paper III, 90 patients (75 %) participated. Patients who were cared for at wards where PCH were employed were more satisfied with nurses’ information provision, and exchange of information between caregivers, than those who evaluated the wards when they used standard handovers. The interviews in Paper II revealed that nurses perceived patients to be both safer and better informed with PCH, but that they struggled in promoting patients’ participation.

In summary, PCH had beneficial consequences on patients’ satisfaction with information exchange between caregivers, and nurses’ information provision, as compared to standard handovers. PCH were not related to patients’ HRQoL or perceptions of information. The results indicate that sufficient time should pass between the first implementation phases and evaluations. The nurse interviews indicated that the actual delivery of PCH differed from the intentions, and that future implementations of PCH should focus on the ethical aspects of person-centered care.