title: [Advanced knowledge of patient preferences for end-of-life care in national health service hospitals of the Murcia Region].
abstract: OBJECTIVE
  Provision of unwanted end-of-life care is an adverse event that can be avoided and is regulated by law. One of the Safe Practices recommended by the National Quality Forum (NQF) is "Ensure that patient preferences regarding end-of-life care are known". Our objective is to assess compliance with this recommendation, and the associated socio-professional factors, in the National Health Service hospitals in the Murcia Region (Spain).
  
  
  METHODS
  Cross-sectional study in 8 hospitals. We measured structure (existence and characteristics of guidelines about advance directives) and process (frequency with which healthcare providers enquire about the preferences of terminally ill patients) indicators, constructed according to the NQF recommendation. The process indicator was measured using a questionnaire distributed to a sample of clinical personnel (n=3141). A descriptive analysis of the results was performed. The association of socio-professional variables with asking patient's preferences (dependent variable) was analysed using multivariate logistic regression.
  
  
  RESULTS
  One of the eight assessed hospitals has valid guidelines. Only 12% of professionals (n=607), (95% confidence interval [CI], 9.4-14.6), responded that they always enquire about the preferences of terminally ill patients in their departments. The existence of guidelines is significantly associated with this response (odds ratio [OR]=18.1; 95% CI, 2.28-143.83) and working in surgical departments with a negative response (OR=0.15; 95% CI, 0.04-0.65).
  
  
  CONCLUSIONS
  There is a very low compliance with the NQF recommendation, evidenced by the lack of guidelines and the low frequency in which terminally ill patients are asked about their preferences for life-sustaining treatment. Implementation of guidelines may help to improve this situation, which is significantly worse in surgical services.
authors: Unidad de Medicina Preventiva y Salud Pública, Universidad de Murcia, Espinardo, Murcia, España. begoft@gmail.com
authors: B
authors: B
authors: Franco Tovar
authors: Z A
authors: ZA
authors: da Silva Gama
authors: P J
authors: PJ
authors: Saturno Hernández
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D016223:Advance Directives; D003430:Cross-Sectional Studies; D004282:Documentation; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006291:Health Policy; D006779:Hospitals, Public / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000458:organization & administration; D009313:National Health Programs / Q000592:standards*; D057240:Patient Preference; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D013030:Spain; D013503:Surgery Department, Hospital / Q000458:organization & administration; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology