July 6, 2022

Room for improvement in end-of-life care, study finds

Doctors “good about ordering comfort care, but not about follow-up”
Even top-flight hospitals like UCLA Medical
Center can improve the way they manage dying patients, according to a
study in Archives of
Internal Medicine
.

Researchers
found that the doctors were excellent at pain control, but did less
well in discussing prognosis and goals of care with patients and
families. Although they performed well in ordering comfort care, they
did less well at follow-up to make sure the care was effective.
The head of the study,
Dr Anne Walling, of the University of California Los Angeles, and her
collaborators analysed the charts of 496 adults hospitalised at least
three days before dying. The patients’ end-of-life care was assessed
based on 13 quality indicators in three areas: eliciting goals of care,
pain assessment and management, and assessment and management of dyspnea
(difficulty in breathing).

Patients received recommended care for 70% of
the quality indicators. Goals of care were addressed in a timely manner
about half the time, pain assessments were performed 94% of the time,
and pain treatments (95%) and dyspnea treatments (87%) were administered
as recommended.

Follow-up
for distressing symptoms, however, was not performed as well as initial
assessments, and only 29% of patients whose ventilation tubes were
removed before death were evaluated for dyspnea. “The findings suggest
much room for improvement in treating patients dying in the hospital,”
the investigators concluded. ~Reuters, Jul 8

Jared Yee
end of life