What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses

Reyniers, Thijs; Houttekier, Dirk; Cohen, Joachim; Pasman, H. Roeline W.; Deliens, Luc

doi:10.1177/0269216314522317

Cited by 46 publications

(67 citation statements)

References 38 publications

(42 reference statements)

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“…For the other countries, one possible explanation might be that older people with dementia who are more highly educated, or married, as well as those aged 65 to 79 and men in general, are more likely to reside at home, but are unable to remain there until the very end of life, resulting in an end-of-life hospital admission and hospital death. 9,36,38 One Dutch study found that for older people, 2 main scenarios were likely: residing in a nursing home, lowering the chances of hospital death, or staying at home as long as possible, with a higher likelihood of hospital death. 39 Consequently, it could be suggested that among older people with dementia, those who are most likely to reside at home, in particular, should be supported by specialist palliative care services to reduce the number of hospital deaths.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Although hospitalization might be considered justified in some circumstances, 9 it also has been suggested that the acute hospital setting is not an adequate place for end-of-life care and death for chronic terminally ill patients and this might be particularly so for patients with advanced dementia. 11e13 In this setting, they may be more likely to experience delirium, 14 falls, or other adverse events, 6,14e16 and often experience burdensome interventions or procedures that might be of little benefit, such as tube feeding.…”

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confidence: 99%

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International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries

Reyniers

Deliens

Pasman

et al. 2015

Journal of the American Medical Directors Association

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115

103

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries

Reyniers

Deliens

Pasman

et al. 2015

Journal of the American Medical Directors Association

Self Cite

115

103

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“…It is evident that preference for home as a place of death decreases as people get older and as the prospect becomes a more pressing reality. 51,59,[66][67][68][69] Evidence from qualitative studies suggests that terminally ill patients may often feel uncertain about their preferences, which are likely to change throughout the course of illness. Such preferences are often not formulated clearly, especially in the face of uncertainty about what will happen throughout the experience of dying.…”

Section: Preferred Place Of Deathmentioning

confidence: 99%

“…Evidence accumulates about the complex situational factors underlying decisions and the varied preferences which may subsequently be expressed. 22,59,66,69,142,180 The focus on place has deflected attention from how death is experienced in different settings. 69,72,73,77,179 Patients tend to adopt a pragmatic stance to place of death.…”

Section: 132139mentioning

confidence: 99%

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

Pollock

Wilson

2015

Health Serv Deliv Res

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(2015) Care and communication between health professionals and patients affected by severe or chronic illness in community settings: a qualitative study of care at the end of life. Health Services Delivery and Research, 3 (31). ISSN 2050-4349 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/35464/2/FullReport-hsdr03310.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution Non-commercial licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by-nc/2.5/ A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.uk This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). HEALTH SERVICES AND DELIVERY RESEARCHEditorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 10/2002/23. The contractual start date was in April 2012. The final report began...

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“…Other treatments are offered on site, as they are in other comparable contexts where hospital admissions are also infrequent. 38 The HC services considered in this study were not equipped to deliver specialized or intensive treatments. 27 In an older US study, HC patients were less often admitted to the hospital and less often exposed to feeding tubes and IV medications, 39 but those patients were in better health (more independent and with a better cognitive performance score) compared with the patients in our study.…”

Section: Typology Of Critical Decisionsmentioning

confidence: 99%

Critical Decisions for Older People With Advanced Dementia: A Prospective Study in Long-Term Institutions and District Home Care

Toscani¹,

Steen²,

Finetti³

et al. 2015

Journal of the American Medical Directors Association

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Objective. To describe and compare the decisions critical for survival or quality of life (CDs) made for patients with advanced dementia in nursing homes (NHs) and home care (HC) services.Design. Prospective cohort study with a follow-up of 6 months.Setting. Lombardy Region (NHs) and Reggio-Emilia and Modena Districts (HC), Italy.Participants. Patients (496 total; 315 in NHs and 181 in HC) with advanced dementia (Functional Assessment Staging Tool score >7) and expected survival >2 weeks.Measurements. At baseline, the patients' demographic data, date of admission and of dementia diagnosis, type of dementia, main co-morbidities, presence of pressure sores, ongoing treatments, and current prescriptions were abstracted from clinical records. At baseline and every 15 days thereafter, information regarding the patients' general condition and CDs (deemed critical by the doctor or team) was collected via interview with the doctor. For each CD, the physician reported the problem that led to the decision, the decision that was eventually made, the purpose of the decision, whether the decision had been discussed with and/or communicated to the family, who made the final decision, whether the decision was maintained after one week, whether it corresponded to what the doctor would have judged appropriate, and the expected survival of the patient (≤15 days).Results. For 267 of the 496 patients (53.8%; 60.3% in NHs and 42.5% at home), 644 CDs were made; for 95 patients, more than one CD was made. The problems that led to a CD were mainly infections (respiratory tract and other infections; 46.6%, 300/644 CDs); nutritional/hydration problems (20.6%; 133 CDs) and the worsening of a pre-existing disease (9.3%; 60 CDs). The most frequent type of decision concerned the prescription of antibiotics (overall 41.1%, 265/644; among NH patients 44.6%, 218/488; among HC patients, 30.2%, 47/156). The decision to hospitalize the patient was more frequently reported for HC than NH patients (25.5% vs. 3.1%). The most frequent purposes of the CDs in both settings were reducing symptoms or suffering (more so in NHs; 81.1 vs. 57.0% in HC) and prolonging survival (NH 27.5%; HC 23.1%; multiple purposes were possible). For 26 decisions (3.8%), the purpose was to ease death or not to prolong life. Conclusions.Decisions critical for the survival or quality of life of patients with advanced dementia were made for approximately half of the patients during a 6-month time frame, and such decisions were made more frequently in NHs than in HC. HC patients were more frequently hospitalized, and a sizeable minority of these patients were treated with the goal of prolonging survival. Italian patients with advanced dementia may benefit from the implementation of 5 palliative care principles, and HC patients may benefit from the implementation of measures to avoid hospitalizing patients near the end of life.

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What justifies a hospital admission at the end of life? A focus group study on perspectives of family physicians and nurses

Abstract: A number of situations have been identified in which nurses and family physicians consider a hospital admission to be justified. Adequate advance care planning and improved psychosocial support to both family and professional caregivers could reduce the number of hospital deaths.

Cited by 46 publications

References 38 publications

International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries

International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

Critical Decisions for Older People With Advanced Dementia: A Prospective Study in Long-Term Institutions and District Home Care

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