In this study quality of care in Dutch hospitals is assessed by reviewing patient records of deceased cancer patients. It is believed, supported mainly by anecdotal knowledge, that the palliative care in Dutch hospitals is suboptimal. The staff lack the knowledge and skills to address patient's problems at the end of life, and don't have the attention to identify those problems. Too often avoidable hospital deaths occur.
In the Netherlands, no nation-wide studies have been conducted to confirm or deny these 'rumors' with scientific evidence--until now. The current study is conducted by Marlies van de Watering, MD, hospice physician in Hospice Bardo.
Investigators
MLH van de
Watering, MD
Prof. L Deliens, PhD
A de Graeff, MD, PhD
Prof. WWA Zuurmond, MD, PhD
P Kostense, PhD
Background
To assess the adequacy of end-of-life care for hospitalised cancer
patients, and identify barriers and facilitators in providing
adequate care. A retrospective analysis of patient records will
provide information on what their recorded problems were and what
care was provided. Based on these data, a palliative care physician
will assess the adequacy of care and care assessment. Scientific
knowledge on the problems hospitalised patients experience at the
end of life, and the quality of palliative care in Dutch hospitals
is lacking. In general, physical, social, psychological, and
spiritual problems worsen near the end of life, but it is unknown
whether, and if so, how these problems are addressed in Dutch
hospitals.
Methods
A retrospective study on records of deceased patients with
the main diagnosis cancer was performed. Hospital records of deceased patients in 9 hospitals across The
Netherlands were
assessed in two phases: first by nurses, then by
palliative care physicians. Questionnaires have been developed for
both phases of data collection for the collection of data on
diagnoses, problems, symptoms, care provided, patient preferences,
and specific palliative care quality indicators. In order to achieve
a better understanding on barriers and facilitators identified in
the patient records, interviews will be conducted with hospital
administrators, physicians, and oncology nurse specialists.
Results (preliminary)
In the first phase of the study, 537 records of deceased cancer
patients were scored. Results showed that the obtained date were
useful, but that the information on pain and symptom management was
insufficient. Only 16.9% of the patients were admitted with the
indication ‘palliative care’. 25% of the patients were admitted for
three days or less; 75% of the patients died within 18 days.
The presence of terms in the records that indicated impending
death was not strongly related to care aim (palliative or curative).
Links
This study was conducted using the methodology and infrastructure of
the
Patient Safety Research Programme.