Advancing the Care Experience for Patients Receiving Palliative Care as They Transition from Hospital to Home (ACEPATH): A Mixed Methods Approach on Evaluating the Readiness for Hospital Discharge of Palliative Care Patients and Caregivers

Abstract

Objective: To examine the association between receipt of the ACEPATH intervention and readiness for hospital discharge, comparing readiness scores pre- and post- intervention administration, as well as integrating RHDS scores with qualitative open-text responses to better understand the “how” of the effectiveness of ACEPATH in improving readiness for hospital discharge. Methods: We conducted a single-arm pilot intervention study, where palliative care patients and their caregivers received the ACEPATH intervention in the form of a guidebook and the delivery of the guidebook by a healthcare provider. We evaluated readiness for hospital discharge using an adapted RHDS for this context, and collected reflection question responses once participants were at home. Results: 13 participants completed the RHDS before and after the ACEPATH intervention was administered, with a median overall increase from 7.20 before the intervention to 7.87 after the intervention (p=0.002). Participants also experienced increased scores among the Knowledge, Personal status, and Coping ability domains, which may be partly attributable to the intervention. Mixed-methods integration suggested that the intervention impacted participants by providing information and reassurance through the guidebook and discussions with the facilitators, although medical complexity and limited social supports constrained benefits for some participants. Conclusions: This pilot study provides preliminary evidence that the ACEPATH intervention may increase participant readiness to be discharged, with the adapted RHDS showing good internal consistency in assessing readiness. Improvements in the knowledge and coping ability domains suggest that structured information sharing, and facilitator-guided discussions may be valuable components of supporting a hospital-to-home transition.