End-of-Life Care and Quality of Dying in 23 Acute Geriatric Hospital Wards in Flanders, Belgium

Verhofstede, Rebecca; Smets, Tinne; Cohen, Joachim; Eecloo, Kim; Costantini, Massimo; Noortgate, Nele Van Den; Deliëns, Luc

doi:10.1016/j.jpainsymman.2016.10.363

Cited by 17 publications

(34 citation statements)

References 39 publications

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“…In a recent retrospective study in Spanish hospitals, patients who were at the end stage of their lives received similar therapeutic and diagnosis procedures to acute care patients [14]. This is congruent with other papers published previously: procedures such as catheter insertion, the use of aspirators, and other actions that are common for patient care in a general hospital can make the difference between comfort and discomfort for end-of-life patients [8,15,16].…”

Section: Introductionsupporting

confidence: 77%

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Puente‐Fernández

Roldán-López

Campos-Calderón³

et al. 2020

JCM

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The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.

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Section: Introductionsupporting

confidence: 77%

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Puente‐Fernández

Roldán-López

Campos-Calderón³

et al. 2020

JCM

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“…An estimated 50% of deaths in Australia are expected1 with approximately 54% occurring in hospital,2 with the likelihood of hospitals keeping up in terms of good quality end-of-life care in question 3 4. Similar figures are reported elsewhere,5–8 indicating that this is not just restricted to Australia 9. The numbers of deaths are projected to increase10 in line with a growing, ageing population.…”

Section: Introductionmentioning

confidence: 71%

Improving quality in hospital end-of-life care: honest communication, compassion and empathy

2019

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BackgroundWith over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: ‘Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…’MethodsThe modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated.FindingsFive themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice.ConclusionLearners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention—behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.

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“…22 Causes of death included oncological disease, infections, and organ failure. 39,40 Dementia itself was listed as a cause of death in 4 studies. 20,31,39,40 In summary, medical reasons for hospital admission of patients with dementia included fractures, sepsis, and new organ disease or failure that was judged to require fresh assessment and management in the inpatient setting.…”

Section: Summary Of Studiesmentioning

confidence: 99%

“…There was inconsistency and overlap between studies around the classification of interventions. For example, provision of artificial fluids and nutrition was classed both as aggressive 33 and standard 40 care intervention. Classification definitions for aggressive or invasive treatments were cited from Morin et al 33 and Richardson et al 2001.…”

Section: Summary Of Studiesmentioning

confidence: 99%

Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting

Moon

McDermott

Kissane

2018

Am J Hosp Palliat Care

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End-of-Life Care and Quality of Dying in 23 Acute Geriatric Hospital Wards in Flanders, Belgium

Abstract: Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms.

Cited by 17 publications

References 39 publications

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

Improving quality in hospital end-of-life care: honest communication, compassion and empathy

Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting

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