How common are palliative care needs among older people who die in the emergency department?

Beynon, Teresa; Gomes, Bárbara; Murtagh, Fliss E.M.; Glucksman, E; Parfitt, Andy; Burman, Rachel; Edmonds, Polly; Carey, Ivana; Keep, Jeff; Higginson, Irene J

doi:10.1136/emj.2009.090019

Cited by 60 publications

(23 citation statements)

References 17 publications

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“…Uniformity of proforma users and data entry is essential to enable this information to remain uncompromised and accurately influence health service provision. The outcomes from ongoing service evaluation, for example, looking at the events, which trigger admission can enhance our understanding of our local service user's experiences and how services could be shaped to support them 8 10…”

Section: Discussionmentioning

confidence: 99%

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The importance of identifying preferred place of death

Ali

Capel²,

Jones

et al. 2015

BMJ Support Palliat Care

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ObjectivesThe majority of people would prefer to die at home and the stated intentions of both statutory and voluntary healthcare providers aim to support this. This service evaluation compared the preferred and actual place of death of patients known to a specialist community palliative care service.DesignAll deaths of patients (n=2176) known to the specialist palliative care service over a 5-year period were examined through service evaluation to compare the actual place of death with the preferred place of death previously identified by the patient. Triggers for admission were established when the patients did not achieve this preference.ResultsBetween 2009 and 2013, 73% of patients who expressed a choice about their preferred place of death and 69.3% who wanted to die at home were able to achieve their preferences. During the course of their illness, 9.5% of patients changed their preference for place of death. 30% of patients either refused to discuss or no preference was elicited for place of death.ConclusionsDirect enquiry and identification of preferences for end-of-life care is associated with patients achieving their preference for place of death. Patients whose preferred place of death was unknown were more likely to be admitted to hospital for end-of-life care.

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Section: Discussionmentioning

confidence: 99%

“…Advance care planning (ACP) including exploring end-of-life care and place of death with patients increases the probability an individual will achieve this preference 9 10. Other factors which influence preferred place of death include age, gender, living with relatives, low functional status and cancer diagnosis 9.…”

Section: Discussionmentioning

confidence: 99%

The importance of identifying preferred place of death

Ali

Capel²,

Jones

et al. 2015

BMJ Support Palliat Care

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“…As the evidence base for palliative care has grown, so too has the conviction that, if a person is given insight into the probable trajectory of their condition, both they and their families will have more opportunity to participate in decisions about end-of-life care. Evidence suggests that a person's lack of awareness of his or her disease stage is likely to result in unnecessary and often unwanted hospital admissions 160 leading to an increased likelihood of dying in hospital; 161,162 a lower likelihood of referral to specialist palliative care services; 163 and less end-of-life planning that would enable them to use 'time left' in a conscious way to 'achieve their personal goals'. 164 Such evidence has combined with culturally informed assumptions about a desire for self-determination to offer a cue to policy-makers to create guidance 5,28,165 that is unequivocal in its promotion of an 'open' awareness context as a person approaches his or her death.…”

Section: Discussionmentioning

confidence: 99%

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Gott

Ingleton

Gardiner

et al. 2013

Health Services and Delivery Research

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BackgroundImproving the provision of palliative and end-of-life care is a priority for the NHS. Ensuring an appropriately managed ‘transition’ to a palliative approach for care when patients are likely to be entering the last year of life is central to current policy. Acute hospitals represent a significant site of palliative care delivery and specific guidance has been published regarding the management of palliative care transitions within this setting.Aims(1) to explore how transitions to a palliative care approach are managed and experienced in acute hospitals and to identify best practice from the perspective of clinicians and service users; (2) to examine the extent of potentially avoidable hospital admissions amongst hospital inpatients with palliative care needs.DesignA mixed-methods design was adopted in two hospitals in England, serving diverse patient populations. Methods included (1) two systematic reviews; (2) focus groups and interviews with 58 health-care professionals to explore barriers to, and facilitators of, palliative care transitions in hospital; (3) a hospital inpatient survey examining palliative care needs and aspects of management including a self-/proxy-completed questionnaire, a survey of medical and nursing staff and a case note review; (4) in-depth interviews with 15 patients with palliative care needs; (5) a retrospective case note review of all inpatients present in the hospital at the time of the survey who had died within the subsequent 12 months; and (6) focus groups with 83 key decision-makers to explore the implications of the findings for service delivery and policy.ResultsOf the 514 patients in the inpatient survey sample, just over one-third (n = 185, 36.0%) met one or more of the Gold Standards Framework (GSF) prognostic indicator criteria for palliative care needs. The most common GSF prognostic indicator was frailty, with almost one-third of patients (27%) meeting this criteria. Agreement between medical and nursing staff and the GSF with respect to identifying patients with palliative care needs was poor. In focus groups, health professionals reported difficulties in recognising that a patient had entered the last 12 months of life. In-depth interviews with patients found that many of those interviewed were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease. The retrospective case note review found that 35 (7.2%) admissions were potentially avoidable. The potential annual cost saving across both hospitals of preventing these admissions was approximately £5.3M. However, a 2- or 3-day reduction in length of stay for these admissions would result in an annual cost saving of £21.6M or £32.4M respectively.ConclusionsPatients with palliative care needs represent a significant proportion of the hospital inpatient population. There is a significant gap between NHS policy regarding palliative and end-of-life care management in acute hospitals in England and current practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…9,10 PC services provided care by giving a multidisciplinary and individualized approach for addressing spiritual distress of advanced CHF patients. LRI therapy might help to reduce the psycho-spiritual needs more effectively with the multidisciplinary approach including input from pastoral worker and social worker.…”

Section: Discussionmentioning

confidence: 99%

Reduction of psycho-spiritual distress of an elderly with advanced congestive heart failure by life review interview in a palliative care day center

Chan

Lau

Cheung

et al. 2016

SAGE Open Medical Case Reports

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Objectives:Major depression is common in patients hospitalized with congestive heart failure and is independently associated with increased re-hospitalization and mortality.Methods:Hereby, we report the treatment for an elderly congestive heart failure patient with frequent emergency department visits having major depression and hopelessness.Results:Treatment outcomes measured showed that depressed scores of psychosocial needs were reduced with life review interview therapy in a palliative care day center.Conclusion:We hypothesize that multidisciplinary team’s approach to treatment was important for this case.

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How common are palliative care needs among older people who die in the emergency department?

Cited by 60 publications

References 17 publications

The importance of identifying preferred place of death

The importance of identifying preferred place of death

Transitions to palliative care for older people in acute hospitals: a mixed-methods study

Reduction of psycho-spiritual distress of an elderly with advanced congestive heart failure by life review interview in a palliative care day center

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