Not the traditional festive season article perhaps, but this review article by Dr Blinderman and the late Dr Billings provides a good summary in a very reputable and widely read journal concerning end of life care in hospitals in the United States.
Is end of life care in hospital in the US different?
The article reports that 29% of deaths take place in hospitals in America, a bit lower than I would have expected. In Australia, 54% die in hospital but this includes inpatient palliative care deaths which are excluded from the US figure of 29%.
According to AIHW, 42% of the Australians who died in hospital had some involvement from palliative care (42% of 54% in hospital deaths is 23%) About a third of patients who died as an admitted patient in hospital (a third of 54% is about 15%) died in inpatient palliative care. That still leaves us behind the US, with around 36% dying in a non palliative inpatient Australian hospital bed compared to 29% in the USA.
Interestingly the NEJM article does not refer to subcutaneous medications which are the mainstay of terminal care medication administration in Australia, New Zealand and the UK. Do US practitioners use less SC medication?
Personally I don’t find that cough and nausea are so troubling at the end of life, and we would promote meticulous mouth care for dry mouth ahead of pharmacological management.
The article also advises us to avoid benzodiazepines for delirium including at the end of life, which I found surprising.
Dear reader, do you have any thoughts? What is end of life care like in hospitals in your neck of the woods?
Are you looking for some reading over the summer holidays (or winter if you’re that way inclined)? Over the next fortnight, we’ll be looking back at some of our posts over the past year. We’ve been to conferences, reflected on clinical and research experiences, shared palliative care educational resources (#FOAMPal) and hosted guest contributors.
A good place to start for palliative care reading is our “Elsewhere in the Palliverse” posts, curated lists of palliative care articles, blog posts, educational resources and the occasional video from Australia, New Zealand, and beyond. This year we’ve shared fifteen “Elsewhere in the Palliverse” posts. We’ve had special editions for events like World Hospice and Palliative Care Day, Dying to Know Day, and Halloween.
To be alerted about new Palliverse posts, follow us on Facebook, Twitter or LinkedIn or hit the “Follow” button in the right-hand column to subscribe to email alerts.
A Christmas wish from Kate Swaffer
Know a hot young palliative care researcher? Or perhaps you ARE a hot young palliative care researcher?
You might be interested to investigate this award for early palliative care researchers. There are other awards for post docs and for clinical research
You will have to get your proverbial skates on as applications close 13th December. The EAPC research congress is in Dublin in June 2016.
Michael Vagg, Barwon Health
It is no coincidence that we describe the “pain” of loneliness or the “agony” of rejected romantic feelings. Paper cuts can be “excruciatingly painful”, but so can watching the social mishaps of Basil Fawlty or David Brent. Personal criticism can be “stinging”.
The book The Patient’s Brain outlines the evidence that later evolutionary traits such as social cognition and language appear to have grafted themselves onto the ancient brain functions that alerted us to external threats or bodily damage.
Words are neurological events. They are meaning-laden puffs of air that our brain transforms into knowledge, opinions, emotions or danger signals.
Shakespeare, perhaps the greatest wordsmith of all time, frequently used bodily sensations including sensitivity to pain as metaphors. If you’ve ever complained about the “bitter cold”, called an ugly sight an “eyesore” or felt it “sharper than a serpent’s tooth … to have a thankless child” you might know what I mean.
Words affect pain
Today, Thursday December 3rd, is the International Day of People with Disabilities.
In 2008, the United Nations adopted a Convention on the Rights of Persons with Disabilities (UN CRPD). In considering this Convention, and our approach to disability, what might this mean for the delivery of palliative care?
The first time one of my medical professionals touched me for comfort rather than during a physical exam, it was during my liver biopsy. I was extremely frightened of the procedure, due to how painful I’d been warned the procedure was, and I was, and still am, slightly uncomfortable with needles (though daily Clexane shots sure sorts that out fast). The medical team at the imaging clinic I attended had gotten in a second nurse, just to hold my hand during the procedure. It was her 60th birthday, and she had been called in, literally, just to hold my hand. I was incredibly moved by this, and incredibly comforted to have someone gently talk me through what was going on – to warn me to look away when the giant liver biopsy needle was brought out, helping me count holding my breath as the needle drew up the cancerous cells, and gently walking me to the recovery room after the procedure finished. It was one of the kindest things I have experienced with my medical professionals – and I have experienced more kindness than I can even recognise. Continue reading