1431P - Review of patient deaths occurring off the end of life pathway: a UK oncology centres4 experience

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Palliative Care
Presenter Claire Mitchell
Authors C.L. Mitchell, T. Colby, R. Berman
  • Medical Oncology, The Christie NHS Foundation Trust, M20 4BX - Manchester/UK



Within the UK national audits have been performed to assess the care of the dying within the NHS and those receiving systemic cancer therapies. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report looked at aspects of end of life care in cancer patients in relation to the appropriateness of the decisions taken and the level of seniority at which clinical decisions were made. We performed an audit to assess patient deaths which did not occur on the end of life pathway (EoLP); specifically the input from senior clinicians in decision making and the appropriateness of ongoing interventions.


All in-patient deaths within our centre for the 6 month period of April 2010 until September 2010 were identified. Patients whose death occurred whilst on the EoLP were identified and excluded from the analysis. A retrospective case note review was then performed for the remaining patients.


In the six month period 82 patient deaths occurred, of these 27% (n = 21) were not on the EoLP at the time of death. 90% of these patients received at least one consultant review during their admission with 58% of the patients having a consultant review within 48hrs of death. At the time of death 84% of the patients were receiving ongoing medical intervention:

Intervention Patients %
Intravenous antibiotics 27
Intravenous fluids 26
Diuretics 15
Steroids 12
Blood Products 8
Table 1: Medical interventions at time of death 95% of the patients had a documented management plan, with a do not resuscitate order present in 73%. 63% of patients had input from the hospital in-patient palliative care team. On review of the clinical notes 68% of the patients fulfilled the criteria for the EoLP.


The audit highlighted that within our current clinical practice a proportion of patients continue to receive ongoing medical intervention despite entering the terminal phase of illness, with clinical decisions often being made at a junior level. Focus on education and training of clinical staff with increased consultant led input into patient care will be aimed at improving end of life care for our patient population.


All authors have declared no conflicts of interest.