Care for dying patients varies depending on type of disease
PATIENTS with dementia get the worst care when dying in hospital -- while standards are highest for cancer sufferers, a new report revealed yesterday.
The research uncovered for the first time that a 'hierarchy' -- based on a person's disease -- exists in the quality of treatment while dying in Irish hospitals.
The findings from the Irish Hospice Foundation emerged in the first audit of treatment provided to patients in their last week of life in 24 acute hospitals and 19 community facilities.
It revealed a sliding scale of care of the dying, depending on the illness -- with cancer at the top followed by patients who suffered a heart attack or stroke, or respiratory conditions like pneumonia or obstructive lung disease.
The report presented to a conference in Dublin yesterday showed that cancer patients could expect a better quality of care when dying, with accommodation in a single room and their relatives with them when they draw their final breath.
But patients suffering from dementia were more likely to die in a ward with several others and had less of a chance of having loved ones with them at the end.
The report also showed that most people who die in hospital are admitted through A&E and that this had a negative impact on their experience.
Most people die in hospital or hospices, with a quarter passing away at home and others dying in nursing homes.
Supports
It found, however, that as many as 25pc of patients who die in hospital could have spent their final days at home if proper supports were available.
Other findings reveal:
- The quality of information given to relatives about various aspects of end-of-life care in hospitals is poor.
- The quality of patient documentation is uneven.
- Wards which have inadequate staffing levels have a significant negative effect on care.
- A third of relatives were not properly informed about the reasons for a post mortem and were less than satisfied with information from the hospital.
- Nurses and doctors are reluctant to make decisions to stop invasive treatments when patients are dying.
- Having a nurse with experience in a ward improves the dying patient's care.
- Care is improved by the quality rather than amount of discussion with patients and relatives.
The report was launched with a new set of quality standards for end-of-life care in hospitals which aims to guide managers and staff on what is needed and acceptable.
The report concluded that overall the quality of end-of-life care in Irish hospitals is high by international standards but there were significant and substantial opportunities to improve it "at every stage of the patient's journey from admission to discharge at death".
Speaking at the conference Irish Hospice Foundation chairman Denis Doherty said it was disappointing that end-of-life care had not progressed further.
It was still necessary to bring it in from the margins to the mainstream of hospital planning and care provision, he said.
He described the report as a "positive piece of work".
- Eilish O'Regan Health Correspondent
Irish Independent
