Clinical Interventions in Aging (Oct 2017)
Understanding institutional stakeholders’ perspectives on multidrug-resistant bacterial organism at the end of life: a qualitative study
Abstract
Maria Heckel,1 Franziska A Herbst,2 Thomas Adelhardt,3 Johanna M Tiedtke,4 Alexander Sturm,5 Stephanie Stiel,2 Christoph Ostgathe1 1Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Bavaria, Germany; 2Institute for General Practice, Hannover Medical School, Hannover, Germany; 3Division of Health Management, School of Business and Economics, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Bavaria, Germany; 4Institute of Psychogerontology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Bavaria, Germany; 5Department of General Internal and Geriatric Medicine, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Hospital of the Order of St John of God Regensburg, Bavaria, Germany Background: Information lacks about institutional stakeholders’ perspectives on management approaches of multidrug-resistant bacterial organism in end-of-life situations. The term “institutional stakeholder” includes persons in leading positions with responsibility in hospitals’ multidrug-resistant bacterial organism management. They have great influence on how strategies on multidrug-resistant bacterial organism management approaches in institutions of the public health system are designed. This study targeted institutional stakeholders’ individual perspectives on multidrug-resistant bacterial organism colonization or infection and isolation measures at the end of life. Methods: Between March and December 2014, institutional stakeholders of two study centers, a German palliative care unit and a geriatric ward, were queried in semistructured interviews. Interviews were audiotaped, transcribed verbatim, and analyzed qualitatively with the aid of the software MAXQDA for qualitative data analysis using principles of Grounded Theory. In addition, two external stakeholders were interviewed to enrich data. Results: Key issues addressed by institutional stakeholders (N=18) were the relevance of multidrug-resistant bacterial organism in palliative and geriatric care, contradictions between hygiene principles and patients’ and family caregivers’ needs and divergence from standards, frame conditions, and reflections on standardization of multidrug-resistant bacterial organism end-of-life care procedures. Results show that institutional stakeholders face a dilemma between their responsibility in protecting third persons and ensuring patients’ quality of life. Until further empirical evidence establishes a clear multidrug-resistant bacterial organism management approach in end-of-life care, stakeholders suggest a case-based approach. Conclusion: The institutional stakeholders’ perspectives and their suggestion of a case-based approach advance the development process of a patient-, family-, staff-, and institutional-centered approach of how to deal with multidrug-resistant bacterial organism-positive patients in end-of-life care. Institutional stakeholders play an important role in the implementation of recommendations following this approach. Keywords: hygiene measures, hygiene procedures, management approach, geriatric care, palliative care, end-of-life care, terminal illness, comorbidity
