Palliative care need and management in the acute hospital setting: a census of one New Zealand Hospital

Abstract

BackgroundImproving palliative care management in acute hospital settings has been identified as a priority internationally. The aim of this study was to establish the proportion of inpatients within one acute hospital in New Zealand who meet prognostic criteria for palliative care need and explore key aspects of their management.MethodsA prospective survey of adult hospital inpatients (n = 501) was undertaken. Case notes were examined for evidence that the patient might be in their last year of life according to Gold Standards Framework (GSF) prognostic indicator criteria. For patients who met GSF criteria, clinical and socio-demographic information were recorded.ResultsNinety-nine inpatients met GSF criteria, representing 19.8% of the total census population. The patients’ average age was 70 years; 47% had a primary diagnosis of cancer. Two thirds had died within 6 months of their admission. Seventy-eight of the 99 cases demonstrated evidence that a palliative approach to care had been adopted; however documentation of discussion about goals of care was very limited and only one patient had evidence of an advance care plan.ConclusionOne fifth of hospital inpatients met criteria for palliative care need, the majority of whom were aged >70 years. Whilst over three quarters were concluded to be receiving care in line with a palliative care approach, very little documented evidence of discussion with patients and families regarding end of life issues was evident. Future research needs to explore how best to support ‘generalist’ palliative care providers in initiating, and appropriately recording, such discussions.

The impact of the environment on patient experiences of hospital admissions in palliative care

“…However, the reality is that most people in developed countries will be cared for and die in other care settings, notably hospital 10. Given that patients with palliative care needs comprise one-quarter to one-third of the total inpatient population,11 12 identifying how the hospital environment can be modified to better meet their needs must be a priority.…”

Patient and family experiences of palliative care in hospital: What do we know? An integrative review

“…Evidence shows that at any one time 13-36% of hospital inpatients meet the criteria for palliative care need. [1][2][3] Hospitals are often the setting where a life limiting diagnosis is made and where patients present when symptoms develop or when they are not well managed. 4 Furthermore for people with illnesses such as chronic obstructive pulmonary disease and congestive cardiac failure, hospitals provide episodic care over many years for illness exacerbations during which death could occur.…”

Necessary but not yet sufficient: a survey of aged residential care staff perceptions of palliative care communication, education and delivery

“…Data collection instrument : The survey contents were adapted from a questionnaire of palliative care education needs, administered to medical and nursing staff in one acute hospital in New Zealand 28. Palliative care issues covered were informed by a systematic review of the literature29 and included: palliative care education (amount, type, format) experience in palliative care delivery, palliative care communication, support and service accessibility.…”