Previous research has shown that hospitals are often ill-prepared to provide care for dying patients. To investigate whether the circumstances for dying on cancer center wards allow for a dignified death, Karin Jors, MA, of the University Medical Center Freiburg, and her colleagues surveyed physicians and nurses in 16 hospitals belonging to 10 cancer centers in Baden-Württemberg, Germany. The survey addressed topics regarding end-of-life care including structural conditions such as rooms and staff, education/training, working environment, family/caregivers, medical treatment, communication with patients, and dignified death.
Among 1131 survey respondents, 57 percent believed that patients could die with dignity on their ward. Half of the survey staff members indicated that they rarely have enough time to care for dying patients, and 55 percent found the rooms available for dying patients unsatisfactory. Only 19 percent of respondents felt that they had been well-prepared to care for dying patients (and only 6 percent of physicians felt so). Palliative care staff reported much better conditions for dying patients than staff from other wards, with 95 percent of palliative care staff indicating that patients die with dignity on their wards. Generally, physicians perceived the circumstances for dying patients much more positively than nurses, especially regarding communication and life-prolonging measures. While 72 percent of physicians reported that patients can usually die a dignified death on their ward, only 52 percent of nurses shared this opinion.
The investigators encourage the integration of palliative care into standard oncology care, beginning as early as diagnosis. They also note that physicians and nurses would benefit from increased education and training in end-of-life care. To promote the development of standards for end-of-life care, establish a comprehensive palliative care curriculum for health care staff, and to encourage further research in this field, the Palliative Care Center of Excellence in Baden-Württemberg (KOMPACT) was established in 2014. "This center combines the expertise of five academic, specialist palliative care departments. We believe that this cooperation is a valuable tool for improving patient care in the end-of-life setting," said Jors.
Jors et al., (2014). Dying in cancer centers: Do the circumstances allow for a dignified death? Cancer, EPub Ahead of Print, DOI: 10.1002/cncr.28702 [Abstract]