Lack of end-of-life support for patients

By Evelyn Ring.  ONE in five hospital patients at the end of their lives could have died at home if there had been enough supports, according to a unique national audit published yesterday.

It found that hospital admissions through emergency departments negatively impact on patients who die in hospital and called for more planned admissions. 

The Irish Hospice Foundation’s audit found significant differences in the assessments by doctors, nurses and relatives of care outcomes and the quality of deaths.

Doctors tend to underestimate the negative aspects of care; relatives tend to overestimate them, while nurses hold the middle ground, it found.

Denis Doherty of the Irish Hospice Foundation said almost every second death occurred in an acute hospital so the organisation had to question why more people did not have the right to die in a place of their choice.

“An audit, of necessity, has to tell it like it is, and, while there are many good things indicated in the audit, it is fair to say that there are many issues which will give us cause for concern,” he said.

The audit, led by social and economic research consultant, Dr Keiran McKeown, looked at 24 acute hospitals and 19 community hospitals. It says most hospital staff receive little or no preparation for different aspects of care at the end of life and there was a need for improving the quality of communications with patients.

The audit also identified a lack of clarity about the role of specialist palliative care services in acute hospitals. It says this role needs to be strengthened and expanded.

It found that the quality of dying in hospitals varied, depending on the patient’s disease. The range, from best to worse, is cancer, circulatory diseases, respiratory diseases and dementia/frailty.

The audit calls for the quality of care for cancer to be extended to all patients.

It found that a third of families who experienced a sudden death did not appear to have been properly informed of the reasons for a postmortem and were less than satisfied with the information provided by the hospital.

All of the hospitals involved in the audit will be preparing a development plan for end of life setting out how each hospital wishes to implement new quality standards also published yesterday by the Irish Hospice Foundation.

Both documents launched in Dublin yesterday were produced by the foundation in association with the Health Service Executive and with financial support from the Atlantic Philanthropies.

For more information:

http://www.irishexaminer.com/ireland/kfcwaucweymh/rss2/#ixzz0oVf0q1ad

http://www.rte.ie/news/2010/0519/health.html