Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation.
BACKGROUND
Many 'routine' interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient's terminal illness situation has any effect on these decisions.


METHODS
Retrospective study of the clinical histories of deceased patients in four hospitals in Granada (Spain) in 2010. Clinical histories corresponding to the last three months of the patient's life were reviewed.


RESULTS
A total of 202 clinical histories were reviewed, 60 % of which were those of non-oncology patients. Opioid prescriptions (58.4 %), palliative sedation (35.1 %) and Do Not Resuscitate (DNR) orders (34.7 %) were the decisions most often reflected in the histories, and differences in these decisions were found between patients registered as terminal and those who were not registered as terminal. The most frequent interventions in the final 14 days and 48 h were parenteral hydration (96-83 %), peripheral venous catheter (90.1-82 %) and oxygen therapy (81.2-70.5 %). There were statistically significant differences between the patients who were registered as terminal and those not registered as terminal in the number of interventions applied in the final 14 days and 48 h (p = 0.01-p = 0.00) and in many of the described treatments.


CONCLUSIONS
The recognition of a patient's terminal status in the clinical history conditions the decisions that are made and is generally associated with a lower number of interventions.
Foundation of Progress and Health, Andalusian Health Service, Granada, Spain.
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Campos-Calderón
Nursing Department, University of Granada, Granada, Spain. rmontoya@ugr.es.
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Montoya-Juárez
Nursing Department, University of Granada, Granada, Spain.
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Hueso-Montoro
General Hospital of the Virgen de las Nieves of Granada, Andalusian Health Service, Granada, Spain.
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Hernández-López
Hospital Santa Ana, Andalusian Health Service, Motril, Spain.
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Ojeda-Virto
Nursing Department, University of Granada, Granada, Spain.
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García-Caro
D032722:Advance Care Planning; D000066491:Clinical Decision-Making; D006761:Hospitals; D006801:Humans; D010166:Palliative Care / Q000379:methods; D000070659:Patient Comfort / Q000379:methods / Q000592:standards; D010818:Practice Patterns, Physicians'; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013030:Spain; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill / Q000706:statistics & numerical data*
Decision making; Delivery of care; End-of-life care; Hospital care; Prognosis; Symptom management