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Review
. 2018 Feb 5;17(1):22.
doi: 10.1186/s12904-018-0275-7.

Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis

André Fringer  1 , Mareike Hechinger  2 , Wilfried Schnepp  3
Affiliations
Review

Transitions as experienced by persons in palliative care circumstances and their families - a qualitative meta-synthesis

André Fringer et al. BMC Palliat Care. .

Abstract

Background: When receiving palliative care, patients and their families experience altered life situations in which they must negotiate challenges in daily life, increased care and new roles. With limited time, they also experience emotional changes that relate to their uncertain future. Transitions experienced in such situations are often studied by focusing on individual aspects, which are synthesized in the following study. The aim was to conduct a qualitative meta-synthesis to explore the experiences patients and their families gain during transitions in palliative care circumstances.

Methods: A qualitative meta-synthesis was conducted following an inductive approach as proposed by Sandelowski and Barroso. Inclusion criteria were studies with adult persons in palliative situations and articles published in English or German. Relevant articles were identified by researching the Pubmed and Cinahl databases, as well as by hand searches in journals and reference lists for the period 2000-2015. The findings of each study were analyzed using initial coding, followed by axial and selective coding in this order. Consequently, a conceptual model was derived from the categories.

Results: In total 2225 articles were identified in the literature search. Finally, 14 studies were included after the selection process. The central phenomenon observed among palliative care patients and their families was maintaining normality during transitions. Transitions are initially experienced unconsciously until a crisis occurs and responsive actions are necessary, which encourages patients and families to perceive the situation consciously and develop strategies for its negotiation. Patients remain caught between hopelessness and valuing their remaining time alive. As the illness progresses, informal caregivers reprioritize and balance their roles, and after death, family members inevitably find themselves in changed roles.

Conclusions: In palliative care situations, transitions are experienced differently by patients and their families in a constant phenomenon that oscillates between unconscious and conscious perceptions of transitions. The derived conceptual model offers an additional perspective to existing models and helps to clarify the phenomenon in practical settings. The study promotes a differentiated conceptual view of transitions and emphasizes patients' and families' perspectives.

Keywords: End of life; Family; Future; Hope; Informal caregiver; Normality; Palliative care; Transitions.

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Conflict of interest statement

Ethics approval and consent to participate

An ethical approval for this study was not necessary as it was a meta-synthesis of published articles and did not involve data collection from participants.

Consent for publication

This study refers to already published articles and does not involve individual person’s data. Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart on study selection process according to the PRISMA guideline [43]
Fig. 2
Fig. 2
Conceptual Model: Transitions experienced by persons in palliative care circumstances and their families
See this image and copyright information in PMC

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