• Merryn Gott, Rosemary Frey, Jackie Robinson, Michal Boyd, Anne O'Callaghan, Naomi Richards, and Barry Snow.
• School of Nursing, University of Auckland, Auckland, New Zealand. m.gott@auckland.ac.nz
• Palliat Med. 2013 Sep 1;27(8):747-56.

BackgroundRecent studies have concluded that there is significant potential to reduce the extent of 'inappropriate' hospitalisations among patients with palliative care needs. However, the nature of, and reasons for, inappropriate hospitalisations within a palliative care context is under-explored.AimTo explore the opinions of 'generalist' palliative care providers regarding the nature of, and reasons for, inappropriate admissions among hospital inpatients with palliative care needs.DesignQualitative study with data collected via individual interviews and focus groups.Setting/ParticipantsParticipants (n = 41) comprised 'generalist' palliative care providers working in acute hospital and community settings.SettingOne District Health Board in an urban area of New Zealand.ResultsThe majority of participants discussed 'appropriateness' in relation to their own understanding of a good death, which typically involved care being delivered in a 'homely' environment, from known people. Differing attitudes among cultural groups were also evident. The following reasons for inappropriate admissions were identified: family carers being unable to cope, the 'rescue culture' of modern medicine, the financing and availability of community services and practice within aged residential care.ConclusionsOn the basis of our findings, we recommend a shift to the term 'potentially avoidable' admission rather than 'inappropriate admission'. We also identify an urgent need for debate regarding the role of the acute hospital within a palliative care context. Interventions to reduce hospital admissions within this population must target societal understandings of death and dying within the context of medicalisation, as well as take into account cultural and ethnic diversity in attitudes, if they are to be successful.

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