End-of-life plans benefit patients and families

Without an EOL plan, it can be difficult for health care providers to provide care which meets the needs of patients.

10 mar 2013—Health care at the end of life is a difficult issue but a new study highlights the importance of making a plan for end-of-life decisions.

The study, published in the Australian Health Review, aimed to identify end-of-life (EOL) decision-making processes for patients with non-cancer illnesses in a major metropolitan hospital.

Lead researcher Dr Susan Lee, from the Palliative Care Research Team at Monash University, said most patients involved in the study did not discuss plans for end-of-life care until the last 24 hours, affecting their quality of care at the end of their lives.

"In 64 per cent of people, the first discussions about EOL care did not occur until the last 24 hours of life. There were some patients who had a clear plan developed with patient/family involvement, which was fully implemented. However, many others had no plan and minimal patient/family involvement in decision-making," Dr Lee said.

"Without an EOL plan, it can be difficult for health care providers to provide care which meets the needs of patients and reflects their priorities and beliefs. For example, decisions about pain relief, resuscitation, the location of treatment as well as psychological and spiritual care can be outlined in an EOL plan which can give health services guidance when providing care."

The study involved a review of 47 randomly selected patient records over a six-month period. This represented 53 per cent of total deaths in the study period.

The study also found the development and effective implementation of EOL plans was associated with the active involvement of both family members and health professionals. It also identified that there were risks in delaying EOL discussions until illness has progressed to a late stage.

Health care services and providers also played an important role. The study found that trust in, and positive communication with, health professionals and timely referral to palliative care help in the development and successful implementation of EOL plans.

"Factors which were associated with having an EOL plan were multiple previous admissions, shorter hospitalisations and being older at the time of death," Dr Lee said.

"Based on this study, more effort needs to be put into promoting the benefits of EOL plans and supporting health services and providers to implement plans as closely as possible. This will assist in improving the quality of care for people at the end of their lives."

Provided by Monash University