Pub Date : 2023-03-01DOI: 10.1136/spcare-2023-pcc.7
B. Johnston, Sahar Khonsari, C. O’Neill
Context People dying in hospitals without specialist palliative care (SPC) input may suffer with significant unmet needs, unrecognised until case-note audit after death. Objectives To evaluate the care of dying hospital inpatients unknown to SPC services across the United Kingdom to better understand their needs and identify factors impacting care of this cohort. Methods Prospective one day UK-wide service evaluation including all dying adult inpatients, excluding those in Emergency Departments/Intensive Care Units. Holistic needs and use of recognised end-of-life care plans (EOLCP) were assessed for those unknown to SPC. Results 88 hospitals, 284 patients. Nearly all patients had unmet holistic needs (93%) which included physical symptoms (75%) and psychological, social and spiritual needs (86%). A dying patient was more likely to have unmet needs and require SPC intervention at a District General Hospital (DGH) compared to a Teaching Hospital/Cancer Centre (Unmet need 98.1% v 91.2% p0.02; Intervention 70.9% v 50.8% p0.001) and when an EOLCP was not utilised (Unmet need 98.3% v 90.3% p0.006; Intervention 67.2% v 53.3% p0.02). Multivariable analyses demonstrated that teaching/cancer hospitals (aOR 0.44 CI 0.26–0.73) and increased SPC medical staffing (aOR 1.69 CI 1.04–2.79) independently influenced need for intervention. However, integration of the use of an EOLCP within the model reduced the impact of SPC medical staffing. Conclusion People dying in hospitals unknown to SPC have significant unmet needs. Further evaluation is required to understand the relationships between patient, staff and service factors in best meeting dying peoples’ needs. The effective content and implementation of EOLCP warrants further investigation.
背景:在没有专科姑息治疗(SPC)投入的医院中死亡的人可能会遭受严重的未满足需求，直到死亡后的病例记录审计才会意识到。目的评估全英国不了解SPC服务的垂死住院患者的护理情况，以更好地了解他们的需求并确定影响该队列护理的因素。方法前瞻性一天全英国范围内的服务评估，包括所有垂死的成年住院患者，不包括急诊科/重症监护病房的患者。对那些不知道SPC的人进行整体需求和使用公认的临终关怀计划(EOLCP)的评估。结果88家医院284例患者。几乎所有患者都有未满足的整体需求(93%)，其中包括身体症状(75%)和心理、社会和精神需求(86%)。与教学医院/癌症中心相比，地区综合医院(DGH)的垂死病人更有可能有未满足的需求并需要SPC干预(未满足的需求98.1% vs 91.2% p0.02;干预70.9% v 50.8% p0.001)和未使用EOLCP时(未满足需求98.3% v 90.3% p0.006;干预67.2% vs 53.3% p0.02)。多变量分析表明，教学/肿瘤医院(aOR 0.44 CI 0.26-0.73)和增加SPC医疗人员(aOR 1.69 CI 1.04-2.79)独立影响干预需求。然而，在模型中集成使用EOLCP减少了SPC医疗人员配置的影响。结论在医院死亡的非SPC患者有明显的未满足需求。需要进行进一步评价，以了解患者、工作人员和服务因素之间的关系，从而最好地满足临终者的需求。EOLCP的有效内容和实施值得进一步研究。
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Pub Date : 2023-03-01DOI: 10.1136/spcare-2023-pcc.8
S. Kite, E. Rees, Joylin Brockett, Jessica Walsh
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