Impact of a legislative framework on quality of end-of-life care and dying in an acute hospital in Spain.
BACKGROUND
In Andalusia, Spain, a legislative framework was put in place in 2010 to guarantee dignity in dying and quality of care in the last phase of life.


OBJECTIVE
The aim of this study was to determine whether health professionals have incorporated the requirements of this legislation into their clinical practice and whether there have been improvements in decision-making procedures affecting the quality of dying in hospitals.


METHODS
A cross-sectional analysis was carried out in an acute hospital in Andalusia, Spain. Clinical records of patients who died in the Costa del Sol Hospital were evaluated before and after the new legislative framework was introduced. Participants were all the patients aged over 18 years (n=398) who died in 2009 (n=216) or 2011 (n=182) of oncological disease or non-oncological chronic disease. Bivariate analyses evaluated differences between the two periods and associations among the patients' characteristics and the context of care.


RESULTS
Provision of information on measures to facilitate comfort and the relief of physical suffering increased from 15.7% to 22.0%, although this was not significant. There was a significant increase in the number of patients who received joint counselling in this regard from doctors and nurses, from 0% in 2009 to 7.1% in 2011.


CONCLUSIONS
The minimal changes found 1 year after the implementation of the framework confirm that culture change is a lengthy, difficult task that cannot be achieved through laws alone.
Nurse Unit Manager, Agencia Pública Empresarial Costa del Sol, Autovía A-7, Km 187, 29603 Marbella, Málaga, Spain.
Juana María
JM
Sepúlveda Sánchez
Director of Nursing, Agencia Pública Empresarial Costa del Sol, Autovía A-7, Km 187, 29603 Marbella, Málaga, Spain.
José Carlos
JC
Canca Sánchez
Quality Control Department Manager, Agencia Pública Empresarial Costa del Sol, Autovía A-7, Km 187, 29603 Marbella, Málaga, Spain.
Enrique
E
Pérez Trueba
Director of Oncology, Agencia Pública Empresarial Costa del Sol, Autovía A-7, Km 187, 29603 Marbella, Málaga, Spain.
Antonio
A
Rueda Dominguez
Director, Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
José Miguel
JM
Morales Asencio
Professor, Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
Isabel María
IM
Morales Gil
D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011787:Quality of Health Care; D013030:Spain; D013727:Terminal Care / Q000331:legislation & jurisprudence / Q000592:standards*