Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-20T04:18:37.721Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessing quality of end-of-life hospital care in a southern European regional health service

Published online by Cambridge University Press:  25 October 2005

Elena Aldasoro ,
Adelina Pérez Alonso ,
Laureano Ribacoba ,
Santiago Esnaola ,
Maite Olaizola ,
Jose Antonio Carrera ,
Ana Bañuelos  and
Rosa Rico
Elena Aldasoro
Affiliation:
Department of Health of the Basque Government
Adelina Pérez Alonso
Affiliation:
Osakidetza/Basque Health Service
Laureano Ribacoba
Affiliation:
Mutua Vizcaya Industrial
Santiago Esnaola
Affiliation:
Department of Health of the Basque Government
Maite Olaizola
Affiliation:
Donostia Hospital
Jose Antonio Carrera
Affiliation:
Donostia Hospital
Ana Bañuelos
Affiliation:
Santa Marina Hospital
Rosa Rico
Affiliation:
Department of Health of the Basque Government
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.

Methods: A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.

Results: End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.

Conclusions: End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

Keywords

Palliative careHospital careQuality of health careTerminally illHealth care surveys
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 4 , October 2005 , pp. 464 - 470
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Axelsson B, Christensen SB. 1997 Medical care utilization by incurable cancer patients in a Swedish county. Eur J Surg Oncol. 23: 145– 150.Google Scholar
Chan A, Woodruff RK. 1991 Palliative care in a general teaching hospital. 1. Assessment of needs. Med J Aust. 155: 597– 599.Google Scholar
Costantini M, Toscani F, Gallucci M, et al. 1999 Terminal cancer patients and timing of referral to palliative care: A multicenter prospective cohort study. J Pain Symptom Manage. 18: 243– 252.Google Scholar
Cowan JD, Palmer TW. 2002 Practical guide to palliative sedation. Curr Oncol Rep. 4: 424– 429.Google Scholar
Critchley P, Jadad AR, Taniguchi A, et al. 1999 Are some palliative care delivery systems more effective and efficient than others? A systematic review of comparative studies. Review. [62 refs]. J Palliat Care. 15: 40– 47.Google Scholar
De Wit R, Van Dam F, Vielvoye-Kerkmeer A, Mattern C, Abu-Saad HH. 1999 The treatment of chronic cancer pain in cancer hospital in The Netherlands. J Pain Symptom Manage. 17: 333– 350.Google Scholar
Grande GE, Todd CJ, Barclay SI, Farquhar MC. 2000 A randomized controlled trial of a hospital at home service for the terminally ill. Palliat Med. 14: 375– 385.Google Scholar
Hearn J, Higginson IJ. 1998 Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 12: 317– 332.Google Scholar
Higginson IJ. 1999 Evidence based palliative care. Editorial. BMJ. 319: 462– 463.Google Scholar
Hinkka H, Kosunen E, Kellokumpu-Lehtinen P, Lammi UK. 2001 Assessment of pain control in cancer patients during the last week of life: Comparison of health centre wards and a hospice. Support Care Cancer. 9: 428– 434.Google Scholar
Hulley SP, Cumming SR. 1988. Designing clinical research. Baltimore: Williams and Wilkins;
Jordhoy MS, Fayers P, Saltnes T, et al. 2000 A palliative-care intervention and death at home: A cluster randomized trial. Lancet. 356: 888– 893.Google Scholar
Kiely MT, Alison DL. 2000 Palliative care activity in a medical oncology unit: The implications for oncology training. Clin Oncol (R Coll Radiol). 12: 179– 181.Google Scholar
Llamas KJ, Pickhaver AM, Piller NB. 2001 Mainstreaming palliative care for patients in the acute hospital setting. Palliat Med. 15: 207– 212.Google Scholar
Lozano A. 1995 La atención del paciente agónico en cuidados paliativos. En: La atención hospitalaria al enfermo moribundo. Quadern CAPS. 23: 38– 40.Google Scholar
Ministerio de Sanidad y Consumo. Cuidados Paliativos. 1993. Recomendaciones de la Sociedad Española de Cuidados Paliativos. Madrid: Ministerio de Sanidad y Consumo;
Mor V, Masterson-Allen S. 1990 A comparison of hospice vs conventional care of the terminally ill cancer patient. Oncology (Williston Park). 4: 85– 91.Google Scholar
Pereira J, Bruera E. 1997. Manual de cuidados paliativos de Edmonton. Edmonton: Alberta;
Raftery JP, Addington-Hall JM, MacDonald LD, et al. 1996 A ramdomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients. Palliat Med. 10: 151– 161.Google Scholar
Rousseau Paul MD. 1995 Hospice and Palliative Care. Dis Mon. 41: 773– 825.Google Scholar
Salisbury C, Bosanquet N, Wilkinson EK, et al. 1999 The impact of different models of specialist palliative care on patients' quality of life: A systematic literature review. Palliat Med. 13: 3– 17.Google Scholar
Sanz Ortiz J. 2001 Final de la vida:? ‘puede ser confortable?’. Med Clin (Barc). 116: 186– 190.Google Scholar
Seale C. 1991 A comparison of hospice and conventional care. Soc Sci Med. 32: 147– 152.Google Scholar
Seamark DA, Williams S, Hall M, Lawrence CJ, Gilbert J. 1998 Palliative terminal cancer care in community hospitals and a hospice: A comparative study. Br J Gen Pract. 48: 1312– 1316.Google Scholar
Societat Valenciana de Medicina Familiar i Comunitaria. 2001. Atención domiciliaria al paciente con cáncer los últimos días de vida. Madrid: Astamedica;
Sykes N, Thorns A. 2003 Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med. 163: 341– 344.Google Scholar
Tschann JM, Kaufman SR, Micco GP. 2003 Family involvement in end-of-life hospital care. J Am Geriatric Soc. 51: 835– 840.Google Scholar
Viney LL, Walker BM, Robertson T, Lilley B, Ewan C. 1994 Dying in palliative care units and in hospital: A comparison of the quality of life of terminal cancer patients. J Consult Clin Psychol. 62: 157– 164.Google Scholar
Von Gunten CF. 2002 Secondary and tertiary palliative care in US hospitals. JAMA. 287: 875– 881.Google Scholar
World Health Organization. 2002. National Cancer Control Programmes. Policies and managerial guidelines. Geneva: World Health Organization;