Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge

Abstract

Most decedents did not receive palliative care during hospital admission, and then only very late in life, limiting its benefits. Improved recognition of palliative need, including earlier identification, regardless of age and disease, will enhance the quality of care for the dying. This article is protected by copyright. All rights reserved.

Specialist Palliative Care Activity at an Acute Care Tertiary Hospital and Its Representation in Administrative Data

“…Palliative care for people with non-cancer conditions is essential to meeting the needs of everyone who could benefit from it 24 ; however, our and other administrative data from Australia and overseas demonstrate that cancer continues to dominate the disease profile of patients coded as receiving PC. 7,24 -30 Our medical record data reported here reveal that this disparity is also evident among recipients of SPC consultations, irrespective of whether or not the patient was coded as having been palliated. Admissions under SPC, whether from initial admission to hospital or after taking over care from another specialist, were also predominately patients with cancer.…”

Perceptions of optimal end‐of‐life care in hospitals: A cross‐sectional study of nurses in three locations

“…A systematic review across 15 countries showed that 38% of end‐of‐life care quality indicators pertain to symptom management (Virdun et al., 2018). Despite this, there is a large body of literature describing often suboptimal symptom management in hospitals for dying patients (Bloomer et al., 2019; Cardona‐Morrell et al., 2017; Donnelly et al., 2018; Mayland et al., 2017; Stubbs et al., 2019; Virdun et al., 2015; Wachterman et al., 2016). For instance, more than three quarters of 57,000 inpatient decedents from the US reported pain in the last month of life and over half reported frequent uncontrolled pain (Meier et al., 2016).…”

“…Access to specialist palliative care is also variable. Among 150,770 older people who died in Australian hospitals, 34.4% received palliative care a median of 10 days before death (Stubbs, Assareh, Achat, & Jalaludin, 2019). Those who were older and had non‐cancer diagnoses received fewer inpatient palliation days and a shorter interval between first palliative admission and death (Stubbs et al., 2019).…”

“…Among 150,770 older people who died in Australian hospitals, 34.4% received palliative care a median of 10 days before death (Stubbs, Assareh, Achat, & Jalaludin, 2019). Those who were older and had non‐cancer diagnoses received fewer inpatient palliation days and a shorter interval between first palliative admission and death (Stubbs et al., 2019). Other studies of dying patients and their families indicate suboptimal experiences of symptom management, bereavement outcomes, and communication (Donnelly, Prizeman, Coimin, Korn, & Hynes, 2018; Mayland, Mulholland, Gambles, Ellershaw, & Stewart, 2017; Virdun, Luckett, Davidson, & Phillips, 2015; Wachterman et al., 2016).…”

Variation in Hospital Use at the End of Life Among New South Wales Residents Who Died in Hospital or Soon After Discharge

“…Those who receive palliative care in the community as early as 6 months before death experience fewer unplanned hospitalizations and ED presentations (Wright et al, 2017). Furthermore, early commencement of in-hospital palliative care (in earlier admissions or even at ED) can result in greater reduction in the cost of hospital care, shorter stays, and fewer in-hospital deaths among inpatients (Assareh, Stubbs, Trinh, Muruganantham, & Achat, 2018; Ireland, 2017; Stubbs, Assareh, Achat, & Jalaludin, 2018; Thomas, Mike, Joshua, & Dorothyann, 2015; Wu, Newman, Lasher, & Brody, 2013).…”