Most hospital patients are dying ‘without suitable care’

A new national study shows most patients in Australia are not getting suitable end-of-life care.

The paper, which looked at nine hospitals across Australia and tracked 1,693 dying patients, showed only 41 per cent of dying patients will ever see a member of the palliative care team. 

The findings show a majority of patients were recognised as dying only late in their hospital stay and only 12 per cent had an advanced care plan, which outlines patients' wishes for when they die.

"At least 60 per cent of people who die in Australia will die in a hospital setting and are at risk of not receiving appropriate end-of-life care," said lead author Professor Imogen Mitchell from The Australian National University. 

Professor Mitchell, an Intensive Care Specialist who is based at Canberra Hospital, says patients should be given the chance to experience a more peaceful journey towards death.

"No one wants to think about dying, but we all need to because it will happen to all of us," she said.

"Frequently when I review imminently dying patients in the ward environment, it feels as if it is the first time they are being told they are dying. 

"Decisions to involve palliative care or initiate a comfort care pathway is often left very late, often in the last 48 hours of life."  

The researchers found a complex range of factors contribute to suboptimal end-of-life care, including failure to identify patients in their last months of life, substandard communication with patients and families, and failure to link medical teams.

"Patients experience inadequate palliative interventions such as delayed pain relief and we found inappropriate and futile investigations and treatments," Professor Mitchell said.

"Engaging the right end-of-life care allows for the best patient experience. 

"No one would like to die in a busy and noisy emergency room with other patients when you could have had a much more peaceful dying journey if planned in advance."

The researchers say it can be challenging for hospitals to co-ordinate appropriate end-of-life care. 

"A gold standard of end of life care is outlined in a consensus statement by the Australian Commission on Safety and Quality in Health Care and should be followed across the nation," Professor Mitchell said. 

"By following these standards our dying patients and their families and carers will have a better experience."

The paper is published in Australian Health Review.