Thousands of National Health Service (NHS) patients in England are "dying badly" each year, according to a report from the Royal College of Physicians (RCP).
There are "significant" disparities in care standards, according to the report. Although many hospitals provided quality care, only about one in four NHS trusts requires that doctors and nurses participate in mandatory training for dying patient care. At 75 percent of hospitals, there were no palliative care professionals on duty during the weekend.
There are also communication issues between patients and staff. In more than half of cases in which dying patients were capable of discussing the subject, healthcare professionals did not inform them, the article states. On average, physicians and staff told friends and relatives the patient was near death 31 hours before death, but one in four of relatives reported feeling uninvolved in their family's care decisions.
Researchers audited 6,580 patient deaths in 149 English hospitals last May, conducted a survey of nearly 1,000 friends or relatives of the deceased and reviewed NHS resources on training for and availability of end-of-life care. "Too many patients are dying badly in our hospitals when we know how to care for them well," John Ellershaw, director of the Marie Curie Palliative Care Institute, which collaborated with the RCP on the research, said in a statement. "If some hospitals can provide good outcomes in care then all hospitals can."
To resolve these problems, the RCP made several recommendations, including:
Implement face-to-face specialist palliative care service in hospitals from 9 a.m. to 5 p.m., seven days a week.
Start mandatory end-of-life care training, including communication and family support education.
Assess dying patients' pain levels at least four times hourly, and give medicine promptly if necessary, while discussing potential interventions with the patients when possible.
Perform local care audits of dying patients, "including the assessment of the views of bereaved relatives," at least once a year.
Research last year found that palliative care that actively involves patients results in lower costs and better outcomes, FierceHealthcare previously reported.