Quality of Care at End-of-Life

July 29, 2010
Lisa Schulmeister

Communication about goals and plans is often lacking.

End-of-life care and decision-making have received increased attention in recent years. Although most end-of-life care still is provided in acute care hospitals, it may also be provided in hospices, nursing homes, and patients’ homes. The number of older people is expected to increase, as will the need for end-of-life care. Healthcare providers will need to be prepared to provide this care.

A recent study suggests that improvements in end-of-care planning and decision-making are needed. Researchers at the University of California Los Angeles Medical Center measured the quality of care provided to 496 adult patients who died while being treated there. Most of the patients had advanced cancer or liver disease, and the median duration of hospitalization was 15 days. The researchers used ten end-of-life measures and two pain measures from the Assessing Care of Vulnerable Elders (ACOVE) tool, and added a measure on implanted defibrillator use. The measures, categorized into three domains of end-of-life care, were goals of care, pain assessment and management, and dyspnea assessment and management. The researchers found that there were deficits in communication, dyspnea assessment, constipation management, and implantable defibrillator deactivation. Interesting findings are that 82% of the patients were admitted to the intensive care unit, with a median stay of 10 days, and 32% received cardiopulmonary resuscitation at least once during their hospitalizations. More than half of the patients lacked documentation about the goals of care in their medical records.

The study findings suggest that discussions about end-of-life care and decision-making need to occur early on, long before patients are on the brink of death. Goals of care should be determined so that everyone—the patient, patient’s family members, and healthcare providers—all are on the same page.

Reference

Walling AM et al. The quality of care provided to hospitalized patients at the end of life. Arch Intern Med. 2010;170:1057-1063.