Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study

Abstract

Background: There is currently debate over the benefits and harms of physician-assisted death. One of the factors influencing this debate is concern about symptoms in the days before death. The objective of this study was to describe the frequency of symptoms before death and determine patient characteristics associated with these symptoms. Methods:We reviewed the medical record of every patient who died at a multisite academic teaching hospital over a 3-month period. We determined the number of episodes of pain, dyspnea, agitation and nausea during the final 48 hours of life and assessed the patient and encounter characteristics associated with 2 or more episodes of symptoms.

Pain in the Have Your Say survey Have Your Say series paper 4

“…Malik's points are made forcefully, and like Mannix's, in the interest of public education. Some research does suggest that Tisdale's estimate of 1% of terminal cases with unmanaged pain might oversell the effectiveness of end-of-life care (Smith et al 2010; Wilkie and Ezenwa 2012; Kobewka et al 2017;Baillie et al 2018). There is also the issue, mentioned by Malik, of inequities in access to palliative care.…”

Perceived Barriers to Discussing End of Life Care Planning

“…According to Kobewka, Ronksley, McIssic, Mulpuru, and Forster (2017), a substantial number of patients have poor symptom control near the time leading up to death which can cause great distress and pain. A retrospective cohort study by Kobewka et al (2017) was conducted with 1065 adult inpatient beds which included patients that died in a three-month period. This convenience sample excluded people who died in the emergency department before admission.…”

Implementation of the integrated palliative care outcome scale in acute care settings – a feasibility study

“…In accordance with Saunders, the WHO (32) and the EAPC (33) highlight the importance of taking into account the four different dimensions of total pain in the care of patients with palliative care needs as well as care of next of kin. Nonetheless, it is still common with high levels of perceived distressing symptoms in advanced stages of life-limiting diseases and at the end-of-life (48,49). Although there is a large variation in the prevalence of described symptoms (48), pain is still the most common symptom in end-of-life regardless of the underlying disease (49)(50)(51)(52)(53).…”

“…Nonetheless, it is still common with high levels of perceived distressing symptoms in advanced stages of life-limiting diseases and at the end-of-life (48,49). Although there is a large variation in the prevalence of described symptoms (48), pain is still the most common symptom in end-of-life regardless of the underlying disease (49)(50)(51)(52)(53). No differences were found when comparing the prevalence of symptoms between different diseases: cancer, chronic heart failure and chronic obstructive pulmonary disease (53).…”

“…However, patients with chronic obstructive pulmonary disease and dementia have been reported to be less relieved from pain compared to patients with cancer (50). Dyspnoea and secretions/death rattles are other distressing symptoms related to breathing that are commonly reported at the end-of-life (48,49). These symptoms are often associated with pulmonary diseases, but may occur in connection with many other diseases, such as chronic heart failure and neurological disorders.…”