Dying in Hospital

Middlewood, Sue; Gardner, Glenn; Gardner, Anne

doi:10.1016/s0885-3924(01)00362-1

Cited by 88 publications

(12 citation statements)

References 12 publications

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“…These results concur with other studies, revealing that even in manifestly terminal conditions, patients were submitted to aggressive measures and important delays in the establishment of palliative objectives [12, 32]. All the same, it is necessary to perform a study with more participants to further support these conclusions.…”

Section: Discussionsupporting

confidence: 90%

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

et al. 2016

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BackgroundMany ‘routine’ interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient’s terminal illness situation has any effect on these decisions.MethodsRetrospective study of the clinical histories of deceased patients in four hospitals in Granada (Spain) in 2010. Clinical histories corresponding to the last three months of the patient’s life were reviewed.ResultsA total of 202 clinical histories were reviewed, 60 % of which were those of non-oncology patients. Opioid prescriptions (58.4 %), palliative sedation (35.1 %) and Do Not Resuscitate (DNR) orders (34.7 %) were the decisions most often reflected in the histories, and differences in these decisions were found between patients registered as terminal and those who were not registered as terminal. The most frequent interventions in the final 14 days and 48 h were parenteral hydration (96–83 %), peripheral venous catheter (90.1–82 %) and oxygen therapy (81.2–70.5 %). There were statistically significant differences between the patients who were registered as terminal and those not registered as terminal in the number of interventions applied in the final 14 days and 48 h (p = 0.01–p = 0.00) and in many of the described treatments.ConclusionThe recognition of a patient’s terminal status in the clinical history conditions the decisions that are made and is generally associated with a lower number of interventions.

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Section: Discussionsupporting

confidence: 90%

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

et al. 2016

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“…In terms of understanding why hospital deaths are so common, current explanations are often derived from anecdote, case studies or qualitative research studies. Factors cited as leading to hospital death often include the complex transition from an active or curative approach to a palliative approach to care - a transition which is not always clear in haematology [6,35-38]. This lack of clarity can arise because some haematological diseases, such as myeloma and follicular lymphoma are considered incurable from diagnosis; thus all treatments, although having the potential to substantially prolong life, are essentially given with palliative intent from the outset.…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of complicating factors, including anaemia, bleeding and infection, can result in the need for ongoing transfusion of blood products, antibiotic and antifungal medication, which may require long term hospitalisation, with death in acute or intensive care settings often being reported [13,32,35,36,43]. …”

Section: Discussionmentioning

confidence: 99%

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

et al. 2010

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BackgroundHaematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients.MethodsA systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis.ResultsCompared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]).ConclusionHome is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred.

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“…Several authors have already noted that in an acute care hospital, such therapeutic interventions, considered as comfort care, were continued for the majority of dying patients [26,29,30]. However, as these studies were retrospective charts reviews, the detailed reasons for the therapeutic procedures could not be clearly determined.…”

Section: Discussionmentioning

confidence: 99%

Palliative inpatients in general hospitals: a one day observational study in Belgium

et al. 2011

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BackgroundHospital care plays a major role at the end-of-life. But little is known about the overall size and characteristics of the palliative inpatient population. The aim of our study was to analyse these aspects.MethodsWe conducted a one-day observational study in 14 randomly selected Belgian hospitals. Patients who met the definition of palliative patients were identified as palliative. Then, information about their socio-demographic characteristics, diagnoses, prognosis, and care plan were recorded and analysed.ResultsThere were 2639 in-patients on the day of the study; 9.4% of them were identified as "palliative". The mean age of the group was 72 years. The primary diagnosis was cancer in 51% of patients and the estimated life expectancy was shorter than 3 months in 33% of patients and longer than 1 year in 28% of patients. The professional caregivers expected for most of the patients (73%), that the treatment would improve patient comfort rather than prolong life. Antibiotics, transfusions, treatments specific to the pathology, and artificial nutrition were administered in 90%, 78%, 57% and 50% of the patients, respectively, but were generally given with a view to controlling the symptoms.ConclusionsThis analysis presents a first national estimate of the palliative inpatient population. Our results confirm that hospitals play a major role at the end-of-life, with one out of ten inpatients identified as a "palliative" patient. These data also demonstrate the complexity of the palliative population and the substantial diversity of care that they can require.

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Dying in Hospital

Cited by 88 publications

References 12 publications

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

Palliative inpatients in general hospitals: a one day observational study in Belgium

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