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BMJ. 2007 December 8; 335(7631): 1176.
PMCID: PMC2128631

Nearly half of all patients dying in English hospitals are not aware they have only hours to live

English hospitals are generally doing what they should be for people who are dying, in terms of stopping some drug treatments and initiating others, but patients’ psychosocial welfare is less well catered for, shows an audit of the care of dying patients.

The audit, which was carried out by the Marie Curie Palliative Care Institute in Liverpool, with the support of the Royal College of Physicians, found that, overall, hospitals are achieving high standards of clinical care for dying patients. For example, non-essential drug treatment was stopped in 93% of patients, and 91% of patients were given pain relief in the last few days or hours of their life.

But hospitals were less good at delivering bad news. Only 57% of the patients had been told that they did not have long to live, and only 45% recognised the nature of their condition. However, over 80% of carers were aware of the diagnosis, indicating that staff find it easier to discuss the issue of dying with relatives and friends.

The spiritual needs of patients also tended to be more neglected than those of their carers. Records showed that only a third of patients had their spiritual needs assessed, whereas 53% of carers had theirs assessed.

For the audit the researchers looked at data from the records of 2672 patients who died in 118 hospitals in England from the start of September to the end of November 2006. The researchers point out, however, that the audit may underestimate the level of care being given, because some care may have been delivered without being documented.

The audit also looked at the use of the Liverpool care pathway for the dying patient, which provides a framework of best practice. The pathway was published in 2003 and was recommended by the National Institute for Health and Clinical Excellence in 2004. The audit found that only 44% of wards that took part in the audit used the pathway. And in the care of only a minority of patients audited—15%—were the recommended protocols used. Thus diagnosing dying remains a clinical challenge, says the report, and more research is needed to help doctors and nurses recognise the signs of approaching death.

Mike Richards, who chairs the advisory board to the Department of Health’s end of life care strategy, said, “How we care for the dying must surely be an indicator of how we care for all our sick and vulnerable patients. Care of the dying is urgent care—with only one opportunity to get it right to create a potential lasting memory for relatives and carers. The audit findings will help hospitals to recognise areas of high achievement and areas where improvements can be made.”

Notes

National Care of the Dying Audit—Hospitals can be seen at www.rcplondon.ac.uk.


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