Quality of dying in hospital general wards: a cross-sectional study about the end-of-life care

Abstract

Background In the last decade, access to national palliative care programs have improved, however a large proportion of patients continued to die in hospital, particularly within internal medicine wards. Objectives To describe treatments, symptoms and clinical management of adult patients at the end of their life and explore whether these differ according to expectation of death. Methods Single-centre cross-sectional study performed in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy. Data on nursing interventions and diagnostic procedure in proximity of death were collected after interviewing the nurse and the physician responsible for the patient. Relationship between nursing treatments delivered and patients’ characteristics, quality of dying and nurses’ expectation about death was summarized by means of multiple correspondence analysis (MCA). Results Few treatments were found statistically associated with expectation of death in the 187 patients included. In the last 48 h, routine (70.6%) and biomarkers (41.7%) blood tests were performed, at higher extent on patients whose death was not expected. Many symptoms classified as severe were reported when death was highly expected, except for agitation and respiratory fatigue which were reported when death was moderately expected. A high Norton score and absence of anti-bedsore mattress were associated with unexpected death and poor quality of dying, as summarized by MCA. Quality of dying was perceived as good by nurses when death was moderately and highly expected. Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6 and 57.8%, denoting a fair agreement between the two professionals (k = 0.24, P < 0.001). The palliative care consultant was requested for only two patients. Conclusion Staff in medical and surgical wards still deal inadequately with the needs of dying people. Presence of hospital-based specialist palliative care could lead to improvements in the patients’ quality of life.

Registered Nurses' beliefs about end‐of‐life care: A mixed method study

“…However, the study also revealed that RNs' cultural, religious, educational and/or ethnic backgrounds may influence end‐of‐life nursing practices (Rittle, 2015 ). This is consistent with existing literature that highlights how cultural norms and education play a crucial role in shaping RNs' beliefs about death and dying and influence the provision of care (Binda et al, 2021 ; Juranić et al, 2023 ). These findings highlight the need to examine these factors to develop recommendations for improving end‐of‐life care practices in Saudi Arabia and internationally.…”

The Role of Hospice Tours in Promoting Hospice Enrollment: A Study of Taiwanese Family Members

“…Family members should be allowed to think about the transfer decision. Clinicians may remind family members that terminally ill, older adult patients who remain in the general ward usually cannot receive adequate physical and psychospiritual care (Binda et al, 2021; Sato et al, 2008). The hospice ward has specialist staff and a thoughtful environment that not only effectively improves the patient’s quality of life but also reduces the burden on caregivers.…”

Noninvasive monitoring technologies to identify discomfort and distressing symptoms in persons with limited communication at the end of life: a scoping review

“…Based on reviews of people dying with dementia and cancer, many may experience pain (12%-96%), difficulty breathing (8%-83%), fatigue (22%-93%), incontinence (32%-65%), and anxiety (6%-57%) [ 2 , 6 ]. Studies in intensive care units (ICU), hospital general wards, nursing homes, and among the general public reported similar percentages of these symptoms, with the addition of agitation (12%—71%) [ 4 , 5 , 7 ], sleep disturbances (18%—56%) [ 7 , 8 ], nausea (9%—59%) [ 4 , 8 ], delirium (75%—91%) [ 3 , 9 , 10 ], fever (16%—61%), and [ 4 , 8 ] pressure sores (16%—42%) [ 3 , 4 ]. To relieve health-related suffering at the end of life, which is a core task of palliative care [ 11 ], it is essential to identify these distressing symptoms in a timely manner.…”