End‐of‐life care of oncology inpatients: Are we getting it right?

Batten, Monique; Nguyen, Bella; Burke, Brandon; Harryanto, Hilman; Mitchell, Imogen; Davis, Alison

doi:10.1111/ajco.13001

Cited by 3 publications

(9 citation statements)

References 21 publications

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“…16 One of the strengths of the study is that it consecutively sampled all in-patient deaths in the four medical units with the highest numbers of deaths in a 4-year period, using a standardised data collection tool informed by prior research. 21 There are also some weaknesses of the current study. First, as a retrospective observational study, this work assumes thorough and accurate clinical records; the potential for incomplete and inaccurate notes to bias findings cannot be quantified.…”

Section: Discussionmentioning

confidence: 87%

“…This study contributes to the growing evidence of variability in quality of end‐of‐life care across medical disciplines . One of the strengths of the study is that it consecutively sampled all in‐patient deaths in the four medical units with the highest numbers of deaths in a 4‐year period, using a standardised data collection tool informed by prior research …”

Section: Discussionmentioning

confidence: 99%

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End‐of‐life care in an Australian acute hospital: a retrospective observational study

Maubach

Batten

Jones

et al. 2019

Internal Medicine Journal

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Background There is a gap in knowledge about the kind and quality of care experienced by hospital patients at the end of their lives. Aims To document and compare the patterns in end‐of‐life care for patients dying across a range of different medical units in an acute care hospital. Methods A retrospective observational study of consecutive adult inpatient deaths between 1 July 2010 and 30 June 2014 in four different medical units of an Australian tertiary referral hospital was performed. Units were selected on the basis of highest inpatient death rates and included medical oncology, respiratory medicine, cardiology and gastroenterology/hepatology. Results Overall, 41% of patients died with active medical treatment plans, but significantly more respiratory and cardiology patients died with ongoing treatment (46 and 75% respectively) than medical oncology and gastroenterology patients (each 27%, P < 0.05). More medical oncology and gastroenterology patients were recognised as dying (92 and 88%) compared with 72% of respiratory and only 38% of cardiology patients (P < 0.001). Significantly, more medical oncology patients were referred to palliative care and received comfort care plans than all other patient groups. However, the rate of non‐palliative interventions given in the final 48 h was not significantly different between all four groups. Conclusions There were differences in managing the dying process between all disciplines. A possible solution to these discrepancies would be to create an integrated palliative care approach across the hospital. Improving and reducing interdisciplinary practice variations will allow more patients to have a high‐quality and safe death in acute hospitals.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

End‐of‐life care in an Australian acute hospital: a retrospective observational study

Maubach

Batten

Jones

et al. 2019

Internal Medicine Journal

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“…Most studies involved single site tertiary hospitals, thus limiting generalisability to smaller non‐urban institutions. Studies used appropriateness criteria existing at the time of the analysis, with four of 35 based on local expert consensus only, and which may have subsequently changed in response to new evidence, such that rates of overuse may not reflect current standards of care. A strength of the review is that studies reflect actual care provided in contemporary real‐world clinical settings in well‐defined clinical circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…For studies of management strategies (Table ), corresponding rates of overuse comprised: 14–74% of blood product infusions among patients with various conditions ( n = 3) 15–55% of older patients receiving at least one inappropriate medication ( n = 7) 34% of chronically prescribed medications of various classes among older patients ( n = 1) 99% of ondansetron prescriptions in patients with severe emesis ( n = 1) 63–90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units ( n = 2) 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions ( n = 1) 21% of antimicrobial prescriptions for patients with acute infections ( n = 1) 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease ( n = 1) 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease ( n = 1) 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk ( n = 1) 10–64% of end‐of‐life care admissions featuring the administration of futile interventions ( n = 3) …”

Section: Studies Of Inappropriate Use Of Investigationsmentioning

confidence: 99%

“…• 14-74% of blood product infusions among patients with various conditions (n = 3) [21][22][23] • 15-55% of older patients receiving at least one inappropriate medication (n = 7) [24][25][26][27][28][29][30] • 34% of chronically prescribed medications of various classes among older patients (n = 1) 31 • 99% of ondansetron prescriptions in patients with severe emesis (n = 1) 32 • 63-90% of regular prescriptions for gastric acid suppressants in patients admitted to intensive care units (n = 2) 33,34 • 34% of regular prescriptions of direct oral anticoagulants in patients with various conditions (n = 1) 35 • 21% of antimicrobial prescriptions for patients with acute infections (n = 1) 36 • 52% of prescriptions for inhaled corticosteroids in patients with mild chronic obstructive pulmonary disease (n = 1) 37 • 55% of instances of high flow oxygen therapy administered to patients with chronic obstructive pulmonary disease (n = 1) 38 • 33% of overnight admissions to medical assessment and planning unit for monitoring and evaluation relating to patients presenting to emergency department with undifferentiated chest pain and low coronary risk (n = 1) 39 • 10-64% of end-of-life care admissions featuring the administration of futile interventions (n = 3) [40][41][42] Of the eight studies reporting post-audit use of QI strategies, 7,[9][10][11]15,19,21,22 professional education strategies, guideline or pathway dissemination, and implementation of algorithms and other forms of decision support were the dominant strategies used. Of the five studies reporting results of post-QI follow-up audits, 7,9,11,15,19 all relating to use of investigations, absolute reductions in rate of overuse ...…”

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confidence: 99%

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Audit‐based measures of overuse of medical care in Australian hospital practice

Scott

2019

Internal Medicine Journal

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Overuse of care that does not confer benefit to patients and wastes limited resources is being increasingly recognised as a major healthcare problem. The preferred measure of overuse of a specific intervention is applying an evidence‐ or consensus‐based measure of inappropriateness directly to the medical records of individual patients who have received the intervention. This study aimed to assess the extent of overuse of care in hospital practice in Australia based on peer‐reviewed literature that reported clinical audits using explicit measures of overuse applied to patient‐level clinical data. Thirty‐five studies met selection criteria, 14 relating to investigations, 21 to management strategies. Overuse rates above 30% were reported for coagulation tests, blood cultures, troponin assays, abdominal imaging studies, use of telemetry, blood product infusions, polypharmacy in older patients, prescriptions for various medications (gastric acid suppressants, direct oral anticoagulants, inhaled corticosteroids), admissions for low‐risk chest pain and futile interventions in end of life care. Hospital physicians may need to audit their current high‐volume practices and ensure they align with current criteria of appropriateness.

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“Do not resuscitate” order and end‐of‐life treatment in a cohort of deceased in a Norwegian University Hospital

Werff

Michelet

Fredheim

et al. 2022

Acta Anaesthesiol Scand

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Background: A "Do not resuscitate" (DNR) order implies that cardiopulmonary resuscitation will not be started. Absent or delayed DNR orders in advanced chronic disease may indicate suboptimal communication about disease stage, prognosis, and treatment goals. The study objective was to determine clinical practice and patient involvement regarding DNR and the prevalence of life-prolonging treatment in the last week of life.Methods: A cross-sectional observational study was made of a cohort of 315 deceased from a large general hospital in Norway. Data on DNR and other treatment limitations, life-prolonging treatment in the last week of life, and cause of death were obtained from medical records.Results: A DNR order was documented for 287 (91%) patients. Almost half the DNR orders, 142 (49%), were made during the last 7 days of life. The main causes of death were cancer (31%), infectious diseases (31%), and cardiovascular diseases (19%). The most frequent life-prolonging treatments during the last week of life were intravenous fluids in 221 patients (70%) and antibiotics in 198 (63%). During the last week of life, 103 (36%) patients received ICU treatment. Death by cancer (odds ratio 2.5, 95% confidence interval 1.24-5.65) and DNR decision made by a palliative care physician (odds ratio 3.4, 95% CI 1.21-3.88) were predictors of not receiving lifeprolonging treatment. Conclusion:The findings of a high prevalence of life-prolonging treatment in the last week of life and DNR orders being made close to the time of death indicate that decisions about limiting life-prolonging treatment are often postponed until the patient's death is imminent."Do not resuscitate" orders, end-of-life care, palliative medicine, treatment limitations

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End‐of‐life care of oncology inpatients: Are we getting it right?

Cited by 3 publications

References 21 publications

End‐of‐life care in an Australian acute hospital: a retrospective observational study

End‐of‐life care in an Australian acute hospital: a retrospective observational study

Audit‐based measures of overuse of medical care in Australian hospital practice

“Do not resuscitate” order and end‐of‐life treatment in a cohort of deceased in a Norwegian University Hospital

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