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Open Access Research article

Palliative care need and management in the acute hospital setting: a census of one New Zealand Hospital

Merryn Gott1, Rosemary Frey1*, Deborah Raphael1, Anne O’Callaghan12, Jackie Robinson12 and Michal Boyd13

Author affiliations

1 Faculty of Medical and Health Sciences, University of Auckland, Building 505, 85 Park Road, Grafton, New Zealand

2 Auckland District Health Board, Auckland, New Zealand

3 Waitemata District Health Board, Westlake, New Zealand

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Citation and License

BMC Palliative Care 2013, 12:15  doi:10.1186/1472-684X-12-15

Published: 28 March 2013

Abstract

Background

Improving palliative care management in acute hospital settings has been identified as a priority internationally. The aim of this study was to establish the proportion of inpatients within one acute hospital in New Zealand who meet prognostic criteria for palliative care need and explore key aspects of their management.

Methods

A prospective survey of adult hospital inpatients (n = 501) was undertaken. Case notes were examined for evidence that the patient might be in their last year of life according to Gold Standards Framework (GSF) prognostic indicator criteria. For patients who met GSF criteria, clinical and socio-demographic information were recorded.

Results

Ninety-nine inpatients met GSF criteria, representing 19.8% of the total census population. The patients’ average age was 70 years; 47% had a primary diagnosis of cancer. Two thirds had died within 6 months of their admission. Seventy-eight of the 99 cases demonstrated evidence that a palliative approach to care had been adopted; however documentation of discussion about goals of care was very limited and only one patient had evidence of an advance care plan.

Conclusion

One fifth of hospital inpatients met criteria for palliative care need, the majority of whom were aged >70 years. Whilst over three quarters were concluded to be receiving care in line with a palliative care approach, very little documented evidence of discussion with patients and families regarding end of life issues was evident. Future research needs to explore how best to support ‘generalist’ palliative care providers in initiating, and appropriately recording, such discussions.

Keywords:
Palliative care; End of life; Census; Healthcare; Acute; Hospital