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

Merryn Gott,Rosemary Frey,Jackie Robinson,Anne O’Callaghan,Michal Boyd,Deborah Raphael

doi:10.1186/1472-684x-12-15

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.

Highlights

Improving palliative care management in acute hospital settings has been identified as a priority internationally
Recent research conducted in two acute hospitals in England demonstrated that UK guidelines, which recommend a structured ‘transition’ to a palliative approach to care amongst hospital inpatients likely to be in the last year of their life [17], are very far from being implemented in routine practice, thereby denying many patients a choice to be involved in end of life decisionmaking [18]
Two recent Australian studies have identified a need to improve the diagnosis of dying and optimise the delivery of palliative care in hospital settings [7,20]. It is within this context that we identified an urgent need to build the research evidence base regarding palliative care management within acute hospitals in New Zealand

Summary

Introduction

Improving palliative care management in acute hospital settings has been identified as a priority internationally. Policy in a number of countries recommends these clinicians adopt a palliative approach to care with patients with life limiting illness [13,14,15], defined in New Zealand as an ‘open attitude toward death and dying by all service providers working with patients and their families, [which] respects the wishes of patients in relation to their treatment and care’ [16]. Two recent Australian studies have identified a need to improve the diagnosis of dying and optimise the delivery of palliative care in hospital settings [7,20]

Objectives

Methods

Results

Discussion

Conclusion