Palliative care and end-of-life needs for hospital patients are not consistently recognized by healthcare professionals

Gott M, Ingleton C, Gardiner C, et al.  Transitions to palliative care for older people in acute hospitals: A mixed-methods study  Health Services and Delivery Research. 2013 November: 1(11).

Review question

How are transitions into palliative care currently being managed in hospital settings, and how can this management be improved? Can improving palliative care transition management reduce hospital admissions and length of stay?

Background

During the last year of life, patients will often transition from receiving ‘curative treatments’, which focus on curing or managing disease, to receiving palliative care, which focuses on maximizing quality of life.

Effectively managing the transition from curative treatment in hospital to palliative care can be difficult, in part because it can be challenging for caregivers to recognize when a patient has entered the final months of life, and in part because many caregivers and patients do not adequately discuss patient preferences for end-of-life care.

Understanding the current state of palliative care transition management and uncovering ways to improve transitions can help ensure that patients receive the care they desire, while also saving health system resources through avoiding unnecessary curative treatment.  

How the review was done

Two detailed searches of a number of electronic databases for studies published prior to 2013 were conducted. Studies that focused on managing transitions from curative to palliative care in the United Kingdom (U.K.) were included in the first review, and studies on the impact of avoidable hospitalizations resulting from palliative care were included in the second review.

A total of 1,464 studies were identified in searches, and 12 were included in the review after assessments for eligibility.

This review was funded by the Health Services and Delivery Research program, which is part of the National Institute for Health Research (U.K.).

What the researchers found

Patients are often in need of palliative care, and not aware of their prognosis. Patients are not routinely offered the opportunity to make decisions about end-of-life treatment.

Physicians and nurses often did not recognize when patients qualified for palliative care, and reported difficulties in recognizing that a patient had entered the final months of life.

The results of the review (which found evidence from two U.K. hospitals) suggested that 7.2% of hospital admissions were potentially avoidable, which could yield an annual cost savings.

Conclusion                                               

Patients with palliative care needs represent a significant portion of the hospital inpatient population, but healthcare professionals often have trouble recognizing when patients may require palliative care. Healthcare providers do not adequately communicate with patients about the trajectory of their disease, and do not routinely offer patients the ability to make decisions about their treatment at the end of life. Improving the management of palliative care transitions can reduce hospital admissions and inpatient length of stay, resulting in significant health system cost savings.