In an article published on September 8, 2014 in the early online edition of Cancer, a peer-reviewed journal of the American Cancer Society, researchers show the need for cancer centers to invest more in palliative care services, adequate rooms for dying patients, staff training in end-of-life care, and advance-care-planning standards. The researchers recommend this approach based on results from surveyed physicians and nurses in hospitals within cancer centers in Germany showing that many patients there do not experience a dignified death.
Previous research has shown that hospitals are often ill-prepared to provide care for dying patients. To investigate whether the circumstances for dying on cancer center wards allow for a dignified death, Karin Jors, MA, of the University Medical Center Freiburg, Germany, and her colleagues surveyed physicians and nurses in 16 hospitals belonging to 10 cancer centers in Baden-W?rttemberg, Germany.
…In our aging society, it is predicted that the number of hospital deaths will continue to rise in the coming years, and many of these deaths will be attributable to cancer…
End-of-life Care
The survey addressed topics regarding end-of-life care including structural conditions such as rooms and staff, education/training, working environment, family/caregivers, medical treatment, communication with patients, and dignified death.
Among 1,131 survey respondents, 57% believed that patients could die with dignity on their ward. Half of the survey staff members 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 dying patients (and only 6% of physicians felt so).
Palliative care staff reported much better conditions for dying patients than staff from other wards, with 95% of palliative care staff indicating that patients die with dignity on their wards. Generally, physicians perceived the circumstances for dying patients much more positively than nurses, especially regarding communication and life-prolonging measures. While 72% of physicians reported that patients can usually die a dignified death on their ward, only 52% of nurses shared this opinion.
A comfortable, dignified experience
“In our aging society, it is predicted that the number of hospital deaths will continue to rise in the coming years, and many of these deaths will be attributable to cancer. For this reason, it is particularly important that cancer centers strive to create a comfortable, dignified experience for dying patients and their families,” said Jors. “Above all, this requires that staff members are provided with the adequate resources to care for these patients.”
The investigators encourage the integration of palliative care into standard oncology care, beginning as early as diagnosis. They also note that physicians and nurses would benefit from increased education and training in end-of-life care.
To promote the development of standards for end-of-life care, establish a comprehensive palliative care curriculum for health care staff, and to encourage further research in this field, the Palliative Care Center of Excellence in Baden-W?rttemberg (KOMPACT) was established in 2014.
“This center combines the expertise of five academic, specialist palliative care departments. We believe that this cooperation is a valuable tool for improving patient care in the end-of-life setting,” Jors said.
In an unrelated study, Garrido, Harrington and Prigerson showed that preferences against life-prolonging care differ dramatically by race/ethnicity. In this study, the researchers noted that life-prolonging care has a uniform significant association with do-not-resuscitate (DNR) order completion rates across racial/ethnic groups of patients with advanced cancer. Advance care planning interventions that target preferences associated with DNR orders across racial/ethnic groups may reach a broad patient population and reduce end-of-life care disparities. The investigators concludes that early education benefits physicians and nurses involved in identifying targets for interventions to reduce end-of-life care disparities among patients with advanced cancer.[2][3]
For more information:
[1] Jors K, Adami S, Xander C, Meffert C, Gaertner J, Bardenheuer H, Buchheidt D, Mayer-Steinacker R, Viehrig M, George W, Becker G. Dying in Cancer Centers: Do the circumstances allow for a dignified death? CANCER; Published Online: September 8, 2014 DOI: 10.1002/cncr.28702.[Article]
[2] Hlubocky FJ. Are patient preferences for end-of-life care socially influenced? Examining J.Cancer. 2014 Aug 21. doi: 10.1002/cncr.28969. [Article][PubMed]
[3] Garrido MM, Harrington ST, Prigerson HG. End-of-life treatment preferences: A key to reducing ethnic/racial disparities in advance care planning? Cancer. 2014 Aug 21. doi: 10.1002/cncr.28970. [Epub ahead of print][Article][PubMed]
Copyright ? 2014 Sunvalley Communication. All rights reserved. Republication or redistribution of Sunvalley Communication content, including by framing or similar means, is expressly prohibited without the prior written consent of Sunvalley Communication. Sunvalley Communication shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Onco’Zine and Oncozine are registered trademarks and trademarks of Sunvalley Communication around the world.
