A Retrospective Audit of End-Of-Life Care In Oncology Patients At The Canberra Hospital

Abstract

Background: There is a national drive toward ensuring that end-of-life (EOL) care is both high quality and tailored toward the individual needs of a patient and their family. Aims: To describe current patterns of EOL care of medical oncology patients dying in an acute hospital setting. Methods: A retrospective observational study was undertaken of 100 consecutive adult medical oncology inpatients dying between 1st July 2010 and 25thJune 2012. Charts were reviewed for evidence of (i) resuscitation plans, (ii) invasive interventions just prior to death, (iii) palliative care and (iv) timing of EOL care in relation to death. Results: At the time of death, 99% of patients had a resuscitation plan, 67% of which were completed by a member of the medical oncology team. 93% of patients were recognized to be dying, and this occurred a median of 2 days prior to death. Within 48 h of death, active interventions were given to 70% of patients with admissions longer than 2 days. Comfort care plans were documented in 87% of patients; however, 66% of these were documented within 48 h of death and up to 29% of these patients continued to receive noncomfort measures. Conclusions: This study showed a high level of documented resuscitation plans, comfort care plans and recognition of dying. However, active interventions were common within 48 h of death, and comfort care plans and recognition of dying often occurred late. Improved documentation with earlier and clearer plans could improve the quality of EOL care. Show more