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Most patients die without proper palliative care, study reveals


Most dying patients in Australian hospitals don’t receive any palliative care, denying them a more peaceful journey towards death.

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A national study which tracked 1693 dying patients at nine hospitals across the country found only 41 per cent of them saw a member of the palliative care team.

A majority of patients weren’t recognised as being in terminal stages until late in their hospital stay and only 12 per cent had an advanced care plan, which outlines their wishes for when they die.

“At least 60 per cent of people who die in Australia will die in a hospital setting and are at risk of not receiving appropriate end-of-life care,” the study’s lead author, Imogen Mitchell from the Australian National University, said.

The intensive care specialist at Canberra Hospital says patients should be given the chance to experience a more peaceful journey towards death.

“No one wants to think about dying, but we all need to because it will happen to all of us,” Professor Mitchell said.

“Frequently when I review imminently dying patients in the ward environment, it feels as if it is the first time they are being told they are dying.”

Decisions to involve palliative care or initiate a comfort care pathway were often left very late, often in the last 48 hours of life.

The researchers found many factors contributed to suboptimal end-of-life care, including failure to identify patients in their last months of life, poor communication with patients and families and a failure to link medical teams.

Patients often experienced inadequate palliative interventions such as delayed pain relief as well as inappropriate and futile investigations and treatments.

“Engaging the right end-of-life care allows for the best patient experience,” Professor Mitchell said.

“No one would like to die in a busy and noisy emergency room with other patients when you could have had a much more peaceful dying journey if planned in advance.”

The researchers say it can be challenging for hospitals to co-ordinate appropriate end-of-life care.

Professor Mitchell said a gold standard of end of life care was outlined in a consensus statement by the Australian Commission on Safety and Quality in Health Care.

“By following these standards our dying patients and their families and carers will have a better experience.”

The paper is published in Australian Health Review.

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