scholarly journals Deaths in critical care and hospice—prevalence, trends, influences: a national decedent cohort study

2021 ◽  
pp. bmjspcare-2021-003157
Author(s):  
Jonathan Mayes ◽  
Stela McLachlan ◽  
Emma Carduff ◽  
Joanne McPeake ◽  
Kirsty J Boyd ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
End Of Life ◽  
Cause Of Death ◽  
Support Services ◽  
Multinomial Logistic Regression ◽  
Population Level ◽  
Critical Care Units ◽  
Location Of Death ◽  
Level Data

ObjectivesEnd-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the characteristics of people who die in critical care units and in hospices, identify factors associated with place of death and report 12-year trends in Scotland.MethodsWe undertook a cohort study of decedents aged ≥16 years in Scotland (2005–2017). Location of death was identified from linkage to the Scottish Intensive Care Society Audit Group database and National Records of Scotland Death Records. We developed a multinomial logistic regression model to identify factors independently associated with location of death.ResultsThere were 710 829 deaths in Scotland, of which 36 316 (5.1%) occurred in critical care units and 42 988 (6.1%) in hospices. As a proportion of acute hospital deaths, critical care deaths increased from 8.0% to 11.2%. Approximately one in eight deaths in those aged under 40 years occurred in critical care. Factors independently associated with hospice death included living in less deprived areas, cancer as the cause of death and presence of comorbidities. In contrast, liver disease and accidents as the cause of death and absence of comorbidities were associated with death in critical care.ConclusionsSimilar proportions of deaths in Scotland occur in critical care units and hospices. Given the younger age profile and unexpected nature of deaths occurring in critical care units, there is a need for a specific focus on end-of-life and bereavement support services in critical care units.

scholarly journals Critical care at the end of life: a population-level cohort study of cost and outcomes

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Dipayan Chaudhuri ◽  
Peter Tanuseputro ◽  
Brent Herritt ◽  
Gianni D’Egidio ◽  
Mathieu Chalifoux ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
End Of Life ◽  
Population Level

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

2020 ◽  
Vol 34 (10) ◽  
pp. 1393-1401
Author(s):  
Luke Mondor ◽  
Walter P Wodchis ◽  
Peter Tanuseputro
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Home Visits ◽  
Population Based ◽  
Relative Index ◽  
Deprived Neighbourhoods ◽  
Location Of Death ◽  
Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

Physician Communication in Pediatric End-of-Life Care

2016 ◽  
Vol 33 (10) ◽  
pp. 935-941 ◽  
Author(s):  
Lori Brand Bateman ◽  
Nancy M. Tofil ◽  
Marjorie Lee White ◽  
Leon S. Dure ◽  
Jeffrey Michael Clair ◽  
...  
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Pediatric Emergency ◽  
Physician Communication ◽  
Life Care ◽  
Parent Communication ◽  
Critical Care Units ◽  
End Of Life Communication

Objective: The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Methods: Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Results: Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Conclusion: Findings indicate that effective physician–parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. Practice Implications: The findings in this study, particularly that physician–parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care.

scholarly journals Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

2014 ◽  
Vol 29 (4) ◽  
pp. 354-362 ◽  
Author(s):  
Maureen Coombs ◽  
Tracy Long-Sutehall ◽  
Anne-Sophie Darlington ◽  
Alison Richardson
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
End Of Life ◽  
Health Care Professionals ◽  
Care Home ◽  
Rare Event ◽  
Community Services ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

scholarly journals Epidemiology of acute kidney injury in Canadian critical care units: a prospective cohort study

2012 ◽  
Vol 59 (10) ◽  
pp. 934-942 ◽  
Author(s):  
Ayodele Odutayo ◽  
Neill K. J. Adhikari ◽  
James Barton ◽  
Karen E. A. Burns ◽  
Jan O. Friedrich ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Kidney Injury ◽  
Critical Care Units

scholarly journals The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying

Societies ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 112 ◽  
Author(s):  
Donna Wilson ◽  
Ye Shen ◽  
Begoña Errasti-Ibarrondo ◽  
Stephen Birch
Keyword(s):  
End Of Life ◽  
Care Service ◽  
Death And Dying ◽  
Population Level ◽  
Developed Countries ◽  
Service Planning ◽  
Hospital Utilization ◽  
Hospital Data ◽  
Political Issues ◽  
Location Of Death

Background: Concern has existed for many years about the extensive use of hospitals by dying persons. In recent years, however, a potential shift out of hospital has been noticed in a number of developed countries, including Canada. In Canada, where high hospital occupancy rates and corresponding long waits and waitlists for hospital care are major socio-political issues, it is important to know if this shift has continued or if hospitalized death and dying remains predominant across Canada. Methods: Recent individual-anonymous population-level inpatient Canadian hospital data were analyzed to answer two questions: (1) what proportion of deaths in provinces and territories across Canada are occurring in hospital now? and (2) who is dying in hospital now? Results: In 2014–2015, 43.9% of all deaths in Canada (excluding Quebec) occurred in hospital. However, considerable cross-Canada differences in end-of-life hospital utilization were found. Some cross-Canada differences in hospital decedents were also noted, although most were older, male, and they died during a relatively short hospital stay after being admitted from their homes and through the emergency department after arriving by ambulance. Conclusion: Over half of all deaths in Canada are occurring outside of hospital now. Cross-Canada hospital utilization and inpatient decedent differences highlight opportunities for enhanced end-of-life care service planning and policy advancements.

Deaths from heart failure and cancer: location trends

2020 ◽  
pp. bmjspcare-2020-002275 ◽  
Author(s):  
Izza Shahid ◽  
Pankaj Kumar ◽  
Muhammad Shahzeb Khan ◽  
Abdul Wahab Arif ◽  
Muhammad Zain Farooq ◽  
...  
Keyword(s):  
Heart Failure ◽  
College Education ◽  
Population Level ◽  
Multivariable Logistic Regression Analysis ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Dying Patients ◽  
Location Of Death ◽  
Level Data ◽  
At Home

BackgroundIncreasing utilisation of hospice services has been a major focus in oncology, while only recently have cardiologists realised the similar needs of dying patients with heart failure (HF). We examined recent trends in locations of deaths in these two patient populations to gain further insight.MethodsComplete population-level data were obtained from the Mortality Multiple Cause-of-Death Public Use Record from the National Center for Health Statistics database, from 2013 to 2017. Location of death was categorised as hospital, home, hospice facility or nursing facility. Demographic characteristics evaluated by place of death included age, sex, race, ethnicity, marital status and education, and a multivariable logistic regression analysis was performed to analyse possible associations.ResultsAmong 2 780 715 deaths from cancer, 27% occurred in-hospital and 14% in nursing facilities; while among 335 350 HF deaths, 27% occurred in-hospital and 30% in nursing facilities. Deaths occurred at hospice facilities in 14% of patients with cancer, compared with just 8.7% in HF (p=0.001). For both patients with HF and cancer, the proportion of at-home and in-hospice deaths increased significantly over time, with majority of deaths occurring at home. In both cancer and HF, patients of non-Hispanic ethnicity (cancer: OR 1.29, (1.27 to 1.31), HF: OR 1.14, (1.07 to 1.22)) and those with some college education (cancer: OR 1.10, (1.09 to 1.11); HF: OR 1.06, (1.04 to 1.09)) were significantly more likely to die in hospice.ConclusionDeaths in hospital or nursing facilities still account for nearly half of cancer or HF deaths. Although positive trends were seen with utilisation of hospice facilities in both groups, usage remains low and much remains to be achieved in both patient populations.

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