Enhancing End-Of-Life Care for Patients and Personnel: A Survey Exploring Personnel’s Experiences and the Potential Impact of an Acute Palliation Kit in the North Denmark Region

Abstract

Background: Many patients want to die at home, but do not get their wishes fulfilled. To combat this, it is important to understand the challenges that stand in the way of healthcare professionals providing quality end-of-life care (EOL) in the patient’s own home.
 Aim: The aims of this study were to 1) determine if staff at Emergency Departments experienced significant challenges related to EOL care, 2) how often this led to unnecessary hospital admissions, and 3) if a new “Acute Palliation Kit” (APK) might alleviate some of the challenges identified above.
 Methods: This was a cross-sectional survey among doctors (n=53) and nurses (n=74) working in Departments of Emergency Medicine or General Practice in the North Denmark Region. The questionnaire covered the healthcare professionals’ backgrounds, their perceptions of current challenges in EOL care, and the potential effects of the APK.
 Results: Among the healthcare professionals, 53% of responders found the most challenging aspect of EOL care to be “Logistic Issues” and 21% “Time consumption”. Out of the responders, 64% had sometimes, often, or always felt the need to admit/maintain admission/push to admit a dying patient, because it was too challenging to start the EOL care at home. On the potential effect of APK, 74% thought it would save time. In addition, most responders thought it would give both the patient and their next of kins better EOL care.
 Conclusion: This study showed that doctors and nurses in Departments of Emergency Medicine found discharging patients to EOL care at home challenging mainly due to logistic problems leading to hospital admissions. This was often contrary to the patient’s wishes and takes time and resources from the healthcare professionals. In the future, logistics of EOL care must be simplified if fewer patients are to be admitted to die. A pre-packed EOL care kit might reduce logistics but needs evaluation in dedicated studies.