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 how adult patients die in the medical and surgical wards of a large tertiary-level university teaching hospital in the north of Italy, comparing the care and treatments between patients whose death was rated as highly, moderately or not expected by nurses. METHODS Single-centre cross-sectional study. 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 qualitative variables involving nursing procedures was summarized by means of multiple correspondence analysis (MCA). RESULTS Death was highly expected by nurses in 108 out of 187 patients included, whose primary diagnosis was respiratory (33.7%). Symptoms control was inadequate for the most severely ill patients: the most prevalent were asthenia (88.3%), mild or severe pain (69.0%), urinary incontinence (66.3%) and respiratory fatigue (64.8%). Physicians rated more frequently than nurses the quality of dying as good or very good, respectively 78.6% and 57.8%. The best quality of dying seems associated to the number of nursing interventions (mostly related to ensure comfort and to prevent pressure ulcers), female sex and low Norton scoring, as suggested by MCA. 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

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

BMC Palliative Care ◽

10.1186/s12904-021-00862-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Filippo Binda ◽

Marco Clari ◽

Gabriella Nicolò ◽

Simone Gambazza ◽

Barbara Sappa ◽

...

Keyword(s):

Palliative Care ◽

Multiple Correspondence Analysis ◽

Cross Sectional Study ◽

Poor Quality ◽

University Teaching ◽

Sectional Study ◽

Unexpected Death ◽

Cross Sectional ◽

Quality Of Dying

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.

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Implementation of an Advance Care Planning Inventory and Its Possible Effect on Quality of Dying: A Nationwide Cross-Sectional Study in Group Homes for Persons with Dementia in Japan

Healthcare ◽

10.3390/healthcare10010062 ◽

2021 ◽

Vol 10 (1) ◽

pp. 62

Author(s):

Seira Takada ◽

Yasuko Ogata ◽

Yoshie Yumoto ◽

Masaomi Ikeda

Keyword(s):

Advance Care Planning ◽

Group Homes ◽

Cross Sectional Study ◽

Care Planning ◽

Sectional Study ◽

Cross Sectional ◽

Quality Of Dying ◽

Advance Care ◽

Planning Implementation

This study aimed to develop an inventory for advance care planning implementation for persons with dementia in group homes and to examine the association between inventory implementation and residents’ quality of dying. A nationwide cross-sectional study was conducted via questionnaires mailed from 2000 group homes in Japan, selected through stratified random sampling. Participants were managers and care planners who had provided end-of-life care for recently deceased residents. The newly developed inventory was used to assess advance care planning implementation for persons with dementia, and the Quality of Dying in Long-term Care Scale was used to evaluate quality of dying. The valid response rate was 28.5% (n = 569). The factor structure of the newly developed Advance Care Planning Practice Inventory and the association between its implementation and quality of dying were verified using factor analysis and internal consistency, and logistic regression, respectively. The composite score and the factor score of the newly developed inventory were significantly associated with quality of dying (p < 0.05). The implementation of advance care planning improves the quality of dying. These findings can be used in development of educational programs, as well as research on advance care planning for care providers.

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