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End-of-life discussions in residential care homes improves symptom control: a national register study
  1. Sofia Andersson1,
  2. Lisa Martinsson2,
  3. Carl Johan Fürst3 and
  4. Margareta Brännström4
  1. 1Department of nursing, Umeå University, Skellefteå, Sweden
  2. 2Department of Radiation Sciences, Umeå University, Umeå, Sweden
  3. 3The Institute for Palliative Care, Lund University and Skåne Regional Council, Lund, Sweden
  4. 4Department of Nursing, Umeå University, Skellefteå, Sweden
  1. Correspondence to Dr Sofia Andersson, Department of nursing, Faculty of Medicine, Umeå University, Umea, Skellefteå, Sweden; sofia.andersson{at}umu.se

Abstract

Background In Europe, residential care homes (RCHs) rather than hospitals are the most common care facilities for the older adult and the place where most deaths occur in this age group. There is a lack of knowledge regarding end-of-life (EOL) discussions and how they correlate with symptoms and symptom relief.

Objective The aim was to examine the correlation between EOL discussions and symptom occurrence, symptom relief and prescriptions or PRN drugs against symptoms for care home residents.

Methods All expected deaths at RCHs from 1 October 2015 to 31 December 2016 and registered in the Swedish Register of Palliative Care were included. Univariate and multivariate logistic regression were used to compare the RCH residents, or their family members, who had received documented EOL discussions with a physician (the EOL discussion group) and the non-EOL discussion group.

Results The EOL discussion group (n=17 071) had a higher prevalence of pain, nausea, anxiety, death rattles and shortness of breath reported, compared with the non-EOL discussion group (n=4164). Those with symptoms were more often completely relieved and had more often been prescribed PRN drugs against that symptom in the EOL discussion group. All differences remained significant when adjusting for age, time living in unit and cause of death.

Conclusion The results indicate that EOL discussions are correlated with higher prevalence of symptoms, but also with better symptom relief and prescription of symptom drugs PRN when symptomatic. A possible explanation for this is that the EOL discussion can work as an opportunity to discuss symptoms and treatment for symptom relief.

  • symptoms and symptom management
  • nursing home care

Data availability statement

No data are available. All data relevant to the study are included in the article.

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Data availability statement

No data are available. All data relevant to the study are included in the article.

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Footnotes

  • Contributors All authors contributed to the design of the study. SA and MB managed data collection. SA analysed the data with input from MB and LM. SA, MB and LM wrote the paper with input and critical review from all authors.

  • Funding This work was supported by the Foundation of Medical Research, Skellefteå.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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