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Tuesday, 1 November 2011: 8:50 AM
Learning Objective 1: The learner will be able to relate that end-of-life care needs and the care provided in hospital are changing.
Learning Objective 2: The learner will be able to report that hospitals have to rapidly change from cure-oriented to comfort-oriented care, with advance planning critical for good deaths.
Although a shift of death out of hospital has taken place, 60% of all deaths in Canada still occur in hospital. The care needed and provided to dying persons in hospital is of considerable interest for ethical and other reasons. Many studies have found end-of-life care in hospital is often cure-oriented, but recent studies are showing palliative care has had a major impact. A Canadian study 14 years ago found only 4% of hospital decedents had received CPR, but with technologies (IV, oxygen, etc.) often used until death occurred. With population aging and healthcare advances meaning 90% of deaths now are not sudden or unexpected, the opportunity to direct care through advance directives and many other changes lead to a repeat study. This study involved a review of 1,018 charts of decedents in 1 recent year at 2 large Canadian hospitals. Only 8.8% had CPR provided immediately prior to death and 13.8% had CPR provided at some point, with age not a significant factor. Females most often needed total care. Having a cancer diagnosis and being <65 greatly increased the likelihood of dying in a Palliative Care Unit. Most died with one or more technologies in use (89% IV and 89% Oxygen). Only 7% had technologies withdrawn near the EOL. Patients with technologies withdrawn were often younger and from a rural area. Yet, 54.6% of deaths were expected and 45.4% not; 96.4% of expected deaths followed a DNR order, and 77% of unexpected deaths had a DNR order. In total, 13.9% did not have a DNR order. Finally, 30.8% had a written living will, while another 0.7% had a verbal living will and another 0.7% of families asked for no resuscitation. End-of-life care developments are occurring, and can be expected as annual deaths double over the current 250,000 per year.
See more of: Palliative Care and End-of-Life Issues
See more of: Oral Paper & Poster: Science Sessions
See more of: Oral Paper & Poster: Science Sessions