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

Desmedt, Marianne; Kethulle, Yolande L de la; Deveugele, Myriam; Keirse, Emmanuel; Paulus, Dominique; Menten, Johan; Simoens, Steven; Berghe, Paul J vanden; Beguin, Claire

doi:10.1186/1472-684x-10-2

Cited by 32 publications

(28 citation statements)

References 27 publications

(36 reference statements)

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“…This figure is comparable with those of other studies, even though there are differences between studies due to methodological differences [12,17,20,23]. In a study in a New Zealand Hospital, 9.2% of cancer patients were assessed to have a palliative care need [23], whereas the corresponding figure in general hospitals in Belgium was 4.8% [12].…”

Section: Discussionsupporting

confidence: 79%

“…However, hospitals are not ideal settings for palliative care patients, as lack of staff and increased time pressure are common problems [10], and the emotional strain of caring for palliative patients can be a challenge [11]. Moreover, healthcare professionals first need to recognize patients as being Bpalliative^and then need to have a readiness to discuss optimal, not maximal, care during their hospitalization [12].…”

Section: Introductionmentioning

confidence: 99%

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Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

Sandgren

Strang

2017

Support Care Cancer

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Purpose The aims of this study were to describe and compare diagnoses, symptoms, and care needs in palliative cancer patients in two medium-sized hospitals in a county council with no specialized palliative care available 24/7; to analyze the relationships between diagnosis and symptoms/care needs; and to compare results and trends from two datasets (from 2007 and 2012). Methods The study was population-based with a crosssectional design and was conducted at two acute care hospitals. We performed 142 one-day inventories (n = 2972) in 2007 and 139 in 2012 (n = 2843) to register symptoms, care needs, and diagnosis based on a questionnaire. Multiple logistic regression models were used in the analysis. Results During 2007 and 2012 combined, 10% (n = 589) of hospitalized patients were assessed as having cancer in a palliative phase. Prostate (12%) and colorectal (12%) cancers were most common. Pain (42%) and deterioration (42%) were the most prevalent symptoms and were associated with pancreas cancer in our regression models (p = 0.003 and p = 0.019, respectively). Other cancers had different associations: hematologic malignancies were associated with infections and blood transfusions (p < 0.001), breast cancer with pleurocentesis (p = 0.002), and stomach/esophagus cancer with nausea (p < 0.001). Nausea was more common in women than in men (p < 0.01). The mean number of symptoms/care needs was 2.9; patients with stomach/esophagus cancer had the highest number of symptoms/care needs (3.5). Conclusions Acute care hospitals still play an important role for patients requiring palliative care. Symptoms and care needs were not strongly associated with specific diagnoses. Therefore, symptoms, rather than the specific cancer diagnoses, should be the focus of care.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

Sandgren

Strang

2017

Support Care Cancer

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“…8 A more recent study in 2011 reported that just 9.4% of hospital patients in Belgium were identified as having palliative care needs. 23 All of these studies used the subjective judgement of generalist medical and nursing staff to identify patients with palliative care need, rather than an objective measure based on diagnostic criteria. Our results show that when using a systematic and objective measure, the percentage of patients with identified need is much higher and represents a substantial proportion of the inpatient population.…”

Section: Discussionmentioning

confidence: 99%

Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK

et al. 2012

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Background: In common with international health policy, The End of Life Care Strategy forEngland has highlighted the delivery of high quality palliative care in the acute hospital setting as an area of priority. Aim:To explore the extent of palliative care need in the acute hospital setting, and to explore agreement between different sources in the identification of patients with palliative care need.Design:: A cross-sectional survey of palliative care need was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Medical and nursing staff were asked to identify patients with palliative care needs. Patients (or consultees) completed assessments of palliative care need.Participants: Of a total inpatient population of 1359, complete datasets were collected for 514 patients/consultees.Results: 36.2% of patients were identified as having palliative care needs according to GSF criteria. Medical staff identified 15.5% of patients as having palliative care needs, and nursing staff 17.4% of patients. Patient self-report data indicated that 83.2% of patients meeting GSF criteria, had palliative care needs. Conclusion: :The results reveal that according to the GSF prognostic guide, over a third of hospital in-patients meet the criteria for palliative care need. Consensus between medical staff, nursing staff and the GSF was poor regarding the identification of patients with palliative care needs. This has significant implications for patient care and draws into question the utility of the GSF in the hospital setting.

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“…123 In a census undertaken in 2001, Gott and colleagues 124 reported that 23% of hospital inpatients were identified as having palliative care needs. A more recent study in 2011 22 reported that just 9.4% of hospital patients in Belgium were identified as having palliative care needs (although this study excluded intensive care units and palliative care units). All of these studies used the subjective judgement of generalist medical and nursing staff to identify patients with palliative care need, rather than an objective measure based on diagnostic criteria, as used in this study.…”

Section: Extent Of Palliative Care Needmentioning

confidence: 99%

“…21 A more recent study in 2011 reported that 9.4% of hospital patients in Belgium were identified as having palliative care needs. 22 However, both of these studies used the subjective judgement of ward-based medical and nursing staff to identify patients with palliative care needs, rather than using an objective measure.…”

Section: The Uk Policy Contextmentioning

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

Cited by 32 publications

References 27 publications

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

Palliative care needs in hospitalized cancer patients: a 5-year follow-up study

Extent of palliative care need in the acute hospital setting: A survey of two acute hospitals in the UK

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

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