DOES DIAGNOSIS MATTER IN END-OF-LIFE DECISION MAKING IN THE HOSPITAL?

Purpose: In the Netherlands one third of all deaths (n=35,000 per year) occurs in a hospital. There is growing interest in palliative care and adequate end-of-life decision making in hospitals. In clinical practice palliative care is mainly focused on the cancer patient, although dying trajectories of non-cancer patients are known to be less predictable. In this study we investigated similarities and differences in end-of-life decision making for cancer and non-cancer patients in the hospital.

Method: All general wards (17) and a specialised unit for acute palliative care in a Dutch university hospital participated in this study. For every patient older than 18 years who had died at one of the participating wards after having been admitted at least 6 hours prior to death, physicians were asked to complete a written questionnaire.

Result: Between June 2009 and February 2011, we received 226 questionnaires. The median age of the deceased patients was 67 years, 56% were male and 49% had cancer. The median length of the last hospitalization was 11 days. During the last month of life, physicians more often discussed end-of-life treatment options with cancer patients than with non-cancer patients (euthanasia: 22% vs 6%*; palliative sedation 41% vs 12%*; intensive symptom control 43% vs 17%*). DNR policy was also more often discussed with cancer patients: 51% vs 34%*.  Physicians were aware of the imminence of death in the large majority of all patients (89% and 83%); no differences between both groups were found in the moment of such awareness. However, physicians discussed imminent death with 67% of cancer patients and with 35% of non-cancer patients*.In the dying phase cancer patients were more often than non-cancer patients treated with opioids (89% vs 66%*) or continuous palliative sedation therapy (35% vs 19%*).

Conclusion: Physicians often recognize imminent death in cancer patients as well as in non-cancer patients. Nevertheless discussion of imminent death and end-of-life decision making is more common in cancer patients than in non-cancer patients. Shared decision making at the end of life could be further improved, especially for non-cancer patients. * Chi-square, p< 0.05