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

Abstract

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.

Oxygen use and survival in patients with advanced cancer and low oxygen saturation in home care: a preliminary retrospective cohort study

“…In this study, more patients who did not use oxygen had risk factors for shorter survival (i.e., decreased level of consciousness, decreased oral intake, and lower performance status) at baseline, compared with those who used oxygen. This finding is consistent with previous studies, in which a diagnosis of "terminal" or "dying" was associated with decisions about the limitation of treatment in patients with cancer [32,33]. The result of this study seems plausible, both clinically and biologically, for several reasons.…”

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

“…In the case of elderly patients, this care is mostly provided by nursing homes. In these centres, most of the beds are privately funded (71%) [12], although some are partially government-funded. In Andalusia, only nursing homes with more than 60 beds are required to offer twenty-four hour nursing services and their own medical care [13].…”

Healthcare Received in the Last Months of Life in Portugal: A Systematic Review

“…Even so, in palliative care, symptom management and the decisions made by health professionals regarding treatment have repercussions for the comfort of the patient. Frequently, the identification of the proximity of death represents an inflection point to avoid the unnecessary suffering for the patient [37]. However, recognizing a patient's proximity to death is difficult and complex [38,39].…”