People dying in UK hospitals without specialist palliative care input often have “significant and poorly identified unmet needs,” according to the first UK-wide evaluation of its kind, published today.
A report published in today’s BMJ Supportive & Palliative Care says 93% of those assessed had demonstrable unmet need – and this was more often the case in district general hospitals than in teaching hospitals or cancer centres.
The Association of Palliative Medicine coordinated the first prospective evaluation of end-of-life care against set standards in 88 hospitals across the UK.
Specialists assessed how well the holistic needs of 284 adult patients nearing death, but not referred to palliative care services, were met on one day between 25 April and 1 May 2022.
The assessment included the ward specialty; age, gender, ethnicity and diagnosis of the patient; presence and severity of physical symptoms; whether psychological, spiritual, and social needs were being met; and if a plan for nutrition and hydration was in place.
The medical and nursing notes were also reviewed to check for evidence of an end-of-life care plan to address identified needs, while any immediate need for specialist palliative care intervention was noted.
Out of the patients assessed, 76% were between 75 and 94 years old; 54% were female; and 98% were white ethnicity. Cancer was the primary diagnosis for 44 (15%) of the patients.
The evaluation found three out of four patients had physical symptoms, such as pain, dyspnoea, respiratory secretions, agitation and nausea/vomiting, with them being moderate to severe in 31%. Mouth care was poor in 56% of patients, while 86% had other unmet holistic care needs, such as spiritual, psychological and social.
There was no plan for nutrition/hydration in 28% of cases (80).
Overall, 93% of the patients reviewed had demonstrable unmet need, the evaluation revealed.
Although a high proportion of patients with end-of-life care plans had unmet needs, this was still significantly more likely without any such care plan in place (98% vs 90%).
The authors acknowledge this is an observational, snapshot study, but they write: “With the Health and Care Act 2022 legislating access to palliative care wherever and whenever needed, these findings raise significant questions about the methods of delivery best suited to meeting the complex needs of dying people.”
They add: “Furthermore, expansion into intermediate care, residential care environments, patients’ homes and other potentially underserved environments is likely to reveal significant unmet specialist palliative care needs.”
The authors conclude their findings should prompt further research and prompt specialists to look again at their specialist palliative care strategic planning.
Tavabie S, Ta Y, Stewart E et al. Seeking Excellence in End of Life Care UK (SEECare UK): a UK multicentred service evaluation. BMJ Supportive & Palliative Care 11 July 2023; doi 10.1136/spcare-2023-004177
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