Diagnosing dying in the acute hospital setting--are we too late?
Studies have shown that end-of-life care within the UK hospital setting is variable, and care pathways are now being advocated in the UK. This report presents results from an audit revealing that it is possible to anticipate a large proportion of deaths within an acute setting, but this is generally achieved very close to the end of life. Forty-nine per cent of patients were recognised as dying 24 hours or less before death, 17% between 24 and 36 hours before death, 21% between 36 and 72 hours before death, and 13% greater than 72 hours before death. It discusses the challenges around making the 'diagnosis of dying' and highlights that if clinicians do not feel confident in performing such a diagnosis, then patients cannot benefit from end-of-life care pathways. Instead of asking healthcare professionals to make accurate prognoses or diagnose dying, an environment needs to be created where teams feel comfortable in actively managing patients (appropriately) alongside considering their symptom control and planning for possible end-of-life care.
Department of Palliative Medicine, University Hospitals of Bristol NHS Foundation Trust and University of Bristol, Bristol Haematology and Oncology Centre. janegibbins@hotmail.com
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Gibbins
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McCoubrie
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Alexander
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Kinzel
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Forbes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D017051:Hospice Care / Q000379:methods*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult