End-of-life care for patients hospitalised in internal medicine departments

Abstract

Objectives: To describe the care provided at the end of life for patients who die in internal medicine departments.

Methods: An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death.

Results: The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P<.001), knew their prognosis (42.6% vs. 8.6%; P<.001), received psychological care (24.9% vs. 8.6%; P<.001), died in an individual room (64.6% vs. 44.4%; P<.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002).

Conclusions: There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.

Keywords: Cuidados al final de la vida; Do-not-resuscitate order; End-of-life care; Enfermedad terminal; In-hospital dying; Muerte en el hospital; Orden de no reanimar; Palliative sedation; Sedación paliativa; Terminal disease.