Abstract
BackgroundThe prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals.MethodsA cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level.ResultsThe response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals.ConclusionsMost Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care providers about these policies is not always provided, and quality assessment tools are used in less than half of the hospitals.
Highlights
The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002
In 2002, Catholic hospitals and nursing homes were surveyed about the prevalence and implementation of policies on euthanasia and other end-of-life decisions
At the time of the survey 63% of the hospitals had a policy on euthanasia, 62% on withholding and/or withdrawing life-sustaining treatment, 27% on palliative sedation, and 14% on pain and symptom control [20] but it was unclear whether these figures were stable or growing
Summary
The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. In recent decades have hospitals in the Western world begun to develop formal end-of-life care policies (written position papers or specific guidelines) on the appropriateness of treatments in terminal care and on end-of-life decisions, such as non-treatment decisions, palliative sedation and euthanasia In countries such as the Netherlands and Belgium, where specific endof-life care legislation, such as the law on patient rights [1], palliative care [2], and the law allowing euthanasia under specific circumstances [3], has been established, health care institutions of different stances felt the need to develop policies to increase transparency, accountability, consistency and quality of terminal care [4,5]. At the time of the survey 63% of the hospitals had a policy on euthanasia, 62% on withholding and/or withdrawing life-sustaining treatment, 27% on palliative sedation, and 14% on pain and symptom control [20] but it was unclear whether these figures were stable or growing
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