Most hospital patients die without adequate end-of-life care, study finds

Most Australian hospital patients are dying without receiving suitable end-of-life care, a new national study has revealed.

Examining end-of-life care in the ward and intensive care unit (ICU) environment across nine Australian hospitals, the study found only 41% of dying patients will ever see a member of the palliative care team.

In total, the study reviewed 1,693 hospital deaths, including 356 in ICU, exploring patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care.

The largest Australian study of hospital deaths revealed most patients were recognised as dying only late in their hospital stay, predominantly within the last 48 hours, with 60% receiving investigations and interventions during this time with late symptom relief. Findings also showed just 12% of patients have existing advance care plans.

“At least 60% of people who die in Australia will die in a hospital setting and are at risk of not receiving appropriate end-of-life care,” the report’s lead author, Professor Imogen Mitchell, from the Australian National University (ANU), said.

An Intensive Care Specialist based at the Canberra hospital, Professor Mitchell believes patients should be given the opportunity to experience a more peaceful end-of-life journey.

“No one wants to think about dying, but we all need to because it will happen to all of us,” she said.

“Frequently when I review imminently dying patients in the ward environment, it feels as if it is the first time they are being told they are dying.

“Decisions to involve palliative care or initiate a comfort care pathway is often left very late, often in the last 48 hours of life.”

Researchers found a range of factors contribute to suboptimal end-of-life care, including failure to identify patients in their last months of life, substandard communication with patients and families, and failure to link medical teams.

“Patients experience inadequate palliative interventions such as delayed pain relief and we found inappropriate and futile investigations and treatments,” Professor Mitchell explained.

“Engaging the right end-of-life care allows for the best patient experience.”

A gold standard of end-of-life care is outlined in a consensus statement by the Australian Commission on Safety and Quality in Health Care and should be followed nationally, Professor Mitchell said.

Read the paper here

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