End-of-life care in acute hospitals: an integrative literature review

Abstract

End-of-life care in acute hospitals: an integrative literature review Aim. To explore and define the current status of published literature related to endof-life care in the acute hospital setting. Background. Chronic illness is now the leading cause of death in developed countries because the population is and the advances in health care delivery. In Australia, two-third of people with chronic illness who die is inpatient in an acute hospital. Whilst most of the attention regarding end-of-life care and dying has focused on palliative care settings, there is a need to consider those dying outside of specialist palliative care settings. Design. Integrative literature review. Methods. Using an integrative approach, electronic searches of selected databases were undertaken, using comprehensive search terms. Secondary sources were also identified through the reference lists of retrieved literature. Results. The literature review identified a lack of high-quality scientific evidence to direct end-of-life care as delivered in the acute (non-palliative care) sector. From the literature available, five core themes/issues were generated to reflect the literature. Conclusions. There is a need for research to investigate end-of-life care in the acute hospital setting. Care pathways are in use to varying degrees without validation, but implementation alone does not ensure quality end-of-life care. Cultural factors can impede/impact practice and the ability of clinicians to recognise 'active dying' has been shown to be problematic, delaying the transition to end-of-life care. Relevance to clinical practice. Given that the majority of deaths in Australia occur in acute hospital settings, clinicians should be delivering expert life-sustaining acute care and also quality end-of-life care.

Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting

“…It has been argued that assessing the quality of data in integrative reviews can be challenging given the range of research methodologies being considered. 43,44 For this reason, the QualSyst tool 44 was used to evaluate the quality of both quantitative and qualitative research data. Using 2 scoring systems, this framework allows for the simultaneous critical appraisal of data while achieving synthesis of research findings.…”

Changes in professionals’ beliefs following a palliative care implementation programme at a surgical department: a qualitative evaluation

“…Palliative care has been implemented in many different ways in a variety of care settings with the aim of giving support to patients, their families, health care professionals and health services, but with mixed results. Some attempts at implementation have highlighted that clinically, there is confusion and ambiguity regarding the concept of palliative care [ 10 , 11 ]. This has created difficulties in determining which patients should receive palliative care, who should provide palliative care and when the care should transition to a palliative phase, which results in an inconsistency in the care [ 12 ] that patients receive [ 10 ].…”

“…Some attempts at implementation have highlighted that clinically, there is confusion and ambiguity regarding the concept of palliative care [ 10 , 11 ]. This has created difficulties in determining which patients should receive palliative care, who should provide palliative care and when the care should transition to a palliative phase, which results in an inconsistency in the care [ 12 ] that patients receive [ 10 ]. According to Pronovost et al [ 13 ] a difficult challenge in the integration of palliative care can be the actions taken by health care professionals, since resuscitation is an automatic response in acute care [ 8 ].…”

A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting

“…Other studies have presented similar views where clinicians had reservations about initiating palliative care and transiting to an end-of-life focus. [27][28][29][30] There is still a focus on acute and interventionist care in acute care settings, and this often contributed to a delayed referral of patients to palliative care. Feelings of failure have also been reported by physicians when they initiate palliative care for their patients in the hospital, even if this was introduced alongside active care.…”