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End-of-Life Care Inadequate

Dying Patients Get Little Pain Relief, Emotional Support From Staff
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WebMD Health News

Jan. 6, 2004 -- A new study shows that end-of-life medical care is best with hospice service vs. hospital or nursing home care.

The research shows many patients dying in hospitals and nursing homes get inadequate physical and emotional care from doctors and nurses who treat them. But this is rare when they receive hospice services during their final days, according to the largest study to date measuring the quality of end-of-life medical care.

After reviewing the deaths of nearly 1,600 patients in 22 states and conducting 120 interviews with those patients' relatives, Brown University researchers say that nearly three in four family members report "excellent" care from hospice services -- in which end-of-life care is either provided at a special facility or at home, largely by family members assisted by visiting specially trained medical personnel. Meanwhile, fewer than half of those whose loved ones spent their final days in other institutions were satisfied. Specifically, the researchers report:

  • According to respondents nearly 25% dying patients did not get enough pain medication, and sometimes got none at all. This was more likely to occur in nursing homes as compared with hospice care.
  • One in three family members say that hospital and nursing home staff didn't provide enough emotional support.
  • Families reported more concerns with the patient being treated with respect when dying, when patients were at a nursing home, hospital, or home with home health services, compared with persons who died at home with hospice services. In addition, 25% felt the doctor's communication was poor.
  • The kicker: Only 15% of respondents said they thought institutional healthcare providers had enough knowledge of the patient to provide the best care possible.

"This lack of support is often someone in the institution who isn't doing the most basic things, even offering common courtesies," researcher Joan Teno, MD, tells WebMD. "When I look at the data, I'm very concerned because by 2020, some 40% of Americans will be dying in nursing homes. This is a major calamity in our healthcare system."

Teno, a professor of community health and medicine at Brown Medical School and associate director of its Center for Gerontology and Health Care Research, says the problems often stem from staffing problems. "Go to any hospital or nursing home and staffing has been cut to bare bones," she says. "Often, they don't have a registered nurse passing out medications, but a licensed practical nurse. That influences choices in care, since a LPN can't give intravenous pain medication." Even when nurses administer medication, they're so busy that they can't tend to the emotional needs of patients or their families.

"The take-home message is that dying patients in a hospital or nursing home need loved ones to act as an advocate, and very clearly, they need to be there in multiple shifts to make sure the patients gets proper care," Teno says. "Based on my own experience as a physician, I can tell you that having someone there who advocates for you improves medical care, since patients can't often do it themselves."

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