title: Dying in cancer centers: do the circumstances allow for a dignified death?
abstract: BACKGROUND
  Prior research has shown that hospitals are often ill-prepared to provide care for dying patients. This study assessed whether the circumstances for dying on cancer center wards allow for a dignified death.
  
  
  METHODS
  In this cross-sectional study, the authors surveyed physicians and nurses in 16 hospitals belonging to 10 cancer centers in Baden-Wuerttemberg, Germany. A revised questionnaire from a previous study was used, addressing the following topics regarding end-of-life care: structural conditions (ie, rooms, staff), education/training, working environment, family/caregivers, medical treatment, communication with patients, and dignified death.
  
  
  RESULTS
  In total, 1131 surveys (response rate = 50%) were returned. Half of the participants indicated that they rarely have enough time to care for dying patients, and 55% found the rooms available for dying patients unsatisfactory. Only 19% of respondents felt that they had been well-prepared to care for the dying (physicians = 6%). Palliative care staff reported much better conditions for the dying than staff from other wards (95% of palliative care staff indicated that patients die in dignity on their ward). Generally, physicians perceived the circumstances much more positively than nurses, especially regarding communication and life-prolonging measures. Overall, 57% of respondents believed that patients could die with dignity on their ward.
  
  
  CONCLUSIONS
  Only about half of the respondents perceived that a dignified death is possible on their ward. We recommend that cancer centers invest more in staffing, adequate rooms for dying patients, training in end-of-life care, advance-care planning standards, and the early integration of specialist palliative care services.
authors.affiliation: Department of Palliative Care, Comprehensive Cancer Center, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Jors
authors.forename: Sandra
authors.initials: S
authors.lastname: Adami
authors.forename: Carola
authors.initials: C
authors.lastname: Xander
authors.forename: Cornelia
authors.initials: C
authors.lastname: Meffert
authors.forename: Jan
authors.initials: J
authors.lastname: Gaertner
authors.forename: Hubert
authors.initials: H
authors.lastname: Bardenheuer
authors.forename: Dieter
authors.initials: D
authors.lastname: Buchheidt
authors.forename: Regine
authors.initials: R
authors.lastname: Mayer-Steinacker
authors.forename: Marén
authors.initials: M
authors.lastname: Viehrig
authors.forename: Wolfang
authors.initials: W
authors.lastname: George
authors.forename: Gerhild
authors.initials: G
authors.lastname: Becker
mesh_terms: D000328:Adult; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D055815:Young Adult
keywords: cancer; end-of-life care; palliative care; quality of health care; specialist palliative care; terminal care