Dying in the hospital setting: A systematic review of quantitative studies identifying the elements of end-of-life care that patients and their families rank as being most important.
BACKGROUND
The majority of expected deaths occur in hospitals where optimal end-of-life care is not yet fully realised, as evidenced by recent reviews outlining experience of care. Better understanding what patients and their families consider to be the most important elements of inpatient end-of-life care is crucial to addressing this gap.


OBJECTIVE
This systematic review aimed to ascertain the five most important elements of inpatient end-of-life care as identified by patients with palliative care needs and their families.


METHODS
Nine electronic databases from 1990 to 2014 were searched along with key internet search engines and handsearching of included article reference lists. Quality of included studies was appraised by two researchers.


RESULTS
Of 1859 articles, 8 met the inclusion criteria generating data from 1141 patients and 3117 families. Synthesis of the top five elements identified four common end-of-life care domains considered important to both patients and their families, namely, (1) effective communication and shared decision making, (2) expert care, (3) respectful and compassionate care and (4) trust and confidence in clinicians. The final domains differed with financial affairs being important to families, while an adequate environment for care and minimising burden both being important to patients.


CONCLUSIONS
This review adds to what has been known for over two decades in relation to patient and family priorities for end-of-life care within the hospital setting. The challenge for health care services is to act on this evidence, reconfigure care systems accordingly and ensure universal access to optimal end-of-life care within hospitals.
Faculty of Health, University of Technology, Sydney, NSW, Australia claudia.virdun@uts.edu.au.
Claudia
C
Virdun
Faculty of Health, University of Technology, Sydney, NSW, Australia Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.
Tim
T
Luckett
Faculty of Health, University of Technology, Sydney, NSW, Australia Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
Patricia M
PM
Davidson
Faculty of Health, University of Technology, Sydney, NSW, Australia Improving Palliative Care through Clinical Trials (ImPaCCT), Sydney, NSW, Australia School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia School of Medicine, The University of Sydney, NSW, Australia.
Jane
J
Phillips
D003142:Communication; D003657:Decision Making; D004645:Empathy; D005190:Family / Q000523:psychology*; D006801:Humans; D010166:Palliative Care / Q000523:psychology*; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D013727:Terminal Care / Q000523:psychology*
Palliative care; consumer participation; hospital; satisfaction; terminal care