Dignified Death Concerns for Cancer Centre Patients

End-of-life cancer care survey reveals resource and training inadequacies

medwireNews: A German survey has identified barriers to a dignified death in patients attending cancer centres in Baden-Wuerttemberg, including a lack of resources and inadequate palliative care training.

Only 56.8% of the 1131 physicians and nurses who completed the questionnaire between 2012 and 2013 believed that it was “usually or always possible for patients to die with dignity” on their ward, report Karin Jors, from University Medical Center Freiburg, and co-investigators.

And 94.8% of staff working on palliative care wards believed dying with dignity was possible compared with just 52.4% of staff working on oncology, general or intensive care wards.

This “striking” difference may reflect well-known barriers to high quality end-of-life care, such as insufficient healthcare personnel education, reimbursement issues encouraging futile aggressive treatment, lack of advance care planning and poor communication, the researchers suggest in Cancer.

Karin Jors et al therefore advocate use of specialist palliative care training, adequate resources and mandatory advance care planning to ensure physicians follow their patients’ end-of-life care priorities.

“To uphold the standard of high-quality care, it is crucial that cancer centers strive to improve conditions for dying patients by ensuring that there are adequate structural conditions and by promoting the integration of palliative care principles on all hospital wards”, they emphasise.

The survey, which was conducted at 16 hospitals belonging to 10 cancer centres, revealed that 50.2% of staff felt there was rarely or never enough time to care for dying patients, although this fell to just 12.1% of palliative care staff. Nevertheless, many staff felt there were insufficient physicians on ward during day (38.2%) and night (70.4%) shifts.

Of concern, just 18.8% of staff felt general training prepared them well to care for dying patients, just 22.0% had received palliative care training and 89.0% said there was “considerable need” for more training on how to care for this patient population.

Only 14.7% of staff felt family or other caregivers were “sufficiently involved” in patient care and just 40.7% stated that these people were encouraged to take part.

The majority (69.4%) of staff said pain medication was used appropriately, but 27.5% said that life-prolonging measures were too often used for terminally ill patients; interestingly, these beliefs differed significantly between physicians and nurses (81.8 vs 65.3% and 12.0 vs 32.5%, respectively).

Finally, 84.6% of staff agreed that it was usually or always appropriate to inform patients about life-prolonging but burdensome treatments and 93.1% said it was generally quite positive to inform patients about their prognosis but only 49.7% felt their patients were usually or always informed about burdensome treatments.

Reference

Jors K, Adami S, Xander C, et al. Dying in cancer centers: Do the circumstances allow for a dignified death? Cancer 2014; Early view 8 September. DOI: 10.1002/cncr.28702

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