Standardization of In-Hospital End-Of-Life Care for Elders Yields Mixed Results

Attempts to implement standardized improvements in end-of-life care in acute hospital settings have not been studied adequately. Investigators in Belgium developed an intervention that involved a multi-professional care guide with “points for attention” for the last days of life, supportive documentation for staff and family caregivers, and an implementation plan. Ten inpatient geriatric services were randomized to deliver this intervention (164 patients) or to provide “usual care,” based on the same points for attention but delivered without the standardized structure and implementation plan (118 patients).

After each patient's death, the most closely involved nurse and family member were asked to assess the quality of the end-of-life experience; rates of response to these standardized assessment questionnaires were about 85% for nurses but only about 25% for family members. Compared with control nurses, intervention nurses reported significantly better patient comfort around dying and no difference in symptom management; in contrast, intervention family members, compared with control family members, noted no difference in in either comfort around dying or symptom management. Intervention family members also reported significantly worse satisfaction with care than did control family members.