Routine engagement in end of life planning can improve health outcomes for people with heart failure
Interventions that encourage healthcare professionals to engage in advance care planning with heart failure patients can work more effectively than stand-alone training activities in improving health outcomes. Approaches that involve patients to change clinicians’ professional practice behaviours, the use of reminder systems and educational meetings may offer the best potential.
There is no cure for heart failure, and palliative care is known to help this patient group. Advance care plann...
Delirium is common among adults receiving palliative care and could be better recognised
Between a quarter and two-thirds of adults admitted to specialist palliative care units experience delirium, or acute confusion.
The findings come from a mixed methods project which included a systematic review of the number of people living with delirium. Estimates are mostly applicable to older adults with advanced cancer.
The project also included interviews with nurses in Australian palliative care units to look at delirium assessment and use of screening tools. The findings highlighted th...
UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay.
In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...
NIHR Themed Review
Comprehensive Care - Older People Living with Frailty in Hospital
People are living longer and many are enjoying healthy lives. However, a significant percentage of older people are particularly vulnerable to even relatively minor changes in their circumstances, and so need particular attention when admitted to a hospital.
Comprehensive Care looks at the concept of ‘frailty’ in older people living in hospital. It brings together NIHR research on what can be done to identify and manage the needs of this group of people and avoid potential problems. With the ri...
An end of life strategy probably improved choice of where to die for people with severe respiratory disease
Most people prefer not to die in hospital, but the majority of patients with long-term diseases other than cancer end up dying there. In England, an NIHR study based on routine collected national data showed that roll-out of the End of Life Care strategy in 2004 was linked to a reduction in deaths in hospital. The number of deaths here fell by 6% for people with chronic obstructive pulmonary disease (COPD), and 3% for people with interstitial lung diseases. However, hospital deaths did not fall ...
How nurses support families of intensive care patients towards the end of life
Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process.
Researchers gathered evidence on how nurses care for patients and their families in intensive care when life-sustaining treatment is withdrawn. The included studies explored the care of the family before, during and after the process. Most of the studies in this small, mixed methods review were qualitative.
Reviewers identified three main ways, or the...
A person’s preferred place to die often goes unrecorded in their notes
Most people say they do not want to die in hospital, but most people do die there. Where wishes are recorded, care is usually better. The preference was not thought to have been recorded for over 80% of people towards the end of life, in this study.
People whose family knew they had a preferred place of death recorded by healthcare staff in England were more likely to avoid dying in hospital. They also had better home care support, quality of life and pain relief during the last three months of...
How to improve ‘do not resuscitate’ decisions in England
This review has highlighted some variations in how ‘do not attempt cardiopulmonary resuscitation’ decisions are made across NHS hospitals. By describing the literature and giving examples where things have gone well and less well in the past it begins to surface promising areas for improvement. These include the designing and implementing of structured forms to record decisions, talking sensitively about the decisions with patients and their families early and letting other health pr...
NIHR Themed Review
Better Endings - right care, right place, right time
Helping people to die with dignity, compassion and comfort is an important goal of any health service. Recent accounts have provided rich insights into some of the challenges for healthcare professionals trying to meet the needs of people at the end of life, ranging from reports of inequalities in access to specialist palliative care to skills and training gaps for general staff caring for the dying.
Better Endings is the NIHR Dissemination Centre’s first Themed Review. It brings together evide...