End-of-life care and hospital medicine. A field experience.

Abstract

A large number of elderly patients end their life in general wards, where they hardly find appropriate for their specific needs. Physicians and nurses, irrespective of their specialization, should be able to provide the dying patients with end-of-life care (EOL-care) to meet their right to die well. Purposely tailored clinical paths, inspired to the comfort care, should be constructed and disseminated. A specific experience carried on for ten years in an Internal Medicine department is reported. After a two-years period of time spent educating a large group of physicians and nurses and to project its own path, the working group experienced substantial improvements for the patients and the staff itself, in terms of a better control of pain and other main disturbing symptoms, avoidance of futile procedures, a better quality of communication and comprehension, harmonization of the clinical decisions brought about by the physicians and the nurses. Based on this experience, the following recommendations are discussed: after preparing the personnel, routinely implement end-of-life care as part of routine practice in a general ward, whenever appropriate; after starting, be aware that nurses are the main actors in the conduction of EOL-care; be aware that EOL-care in no way is a low profile care in as much as it is challenging and demanding task.