A better death: Hospitals need systematic process to heed patient' concerns

The final months and weeks for terminally ill hospital patients could be made better if hospitals simply instituted a systematic process to seek the thoughts of dying patients and families on how to improve the medical care provided, say experts at a leading international medical ethics think tank.

In what may be the first-ever patient-centered study designed to improve end-of-life care, the Joint Centre for Bioethics at the University of Toronto (JCB) says concentrating on issues considered important by patients and their families produces significant improvement in how dying patients perceive the care they get. The research will be published by the UK-based journal BMC Palliative Care Monday, May 24.

"Some 222,000 people die in Canada alone each year yet we have never before used the impressions of patients and their families to improve the care provided at the end of life," says JCB Director Peter Singer.

"Everyone knows someone who dies in pain. When I do a straw poll with audiences, they generally give a B average to end of life care. This study offers the promise of an inexpensive way to tackle the problem of B-grade end of life care.

"Needed, quite simply, is more systematic, direct and intense patient feedback to doctors and other hospital staff."

The study involved 36 seriously ill patients at a Toronto tertiary care hospital. It assessed how patients' perceptions of care changed after a medical resident (who was not part of the treating team) routinely asked about their concerns and relayed that information to the treating staff.

In the initial interviews, the research showed there was "plenty of room for improvement." More than one quarter of the patients rated their overall care as only "good," "fair" or "poor," 72% reported "very good" or "excellent." Asked about symptom control, 64% said "very good" or "excellent", level of support, 66%, and discussions about life sustaining treatments, 75%.'"/>

Contact: Terry Collins
University of Toronto Joint Center for Bioethics

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