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Analysis of end-of-life treatment and physician perceptions at a university hospital in Germany
PURPOSE: Providing state-of-the-art palliative care is crucial in all areas of in- and outpatient settings. Studies on the implementation of palliative care standards for dying patients are rare. METHODS: N = 141 physicians from all internal departments were polled anonymously about the treatment of...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8881441/ https://www.ncbi.nlm.nih.gov/pubmed/33950342 http://dx.doi.org/10.1007/s00432-021-03652-0 |
Sumario: | PURPOSE: Providing state-of-the-art palliative care is crucial in all areas of in- and outpatient settings. Studies on the implementation of palliative care standards for dying patients are rare. METHODS: N = 141 physicians from all internal departments were polled anonymously about the treatment of dying patients using a self-designed questionnaire. Furthermore, we evaluated the terminal care of n = 278 patients who died in internal medicine departments at University Hospital Mannheim between January and June, 2019 based on clinical data of the last 48 h of life. We defined mandatory criteria for good palliative practice both regarding treatment according to patients' records and answers in physicians' survey. RESULTS: Fifty-six physicians (40%) reported uncertainties in the treatment of dying patients (p < 0.05). Physicians caring for dying patients regularly stated to use sedatives more frequently and to administer less infusions (p < 0.05, respectively). In multivariate analysis, medical specialization was identified as an independent factor for good palliative practice (p < 0.05). Physicians working with cancer patients regularly were seven times more likely to use good palliative practice (p < 0.05) than physicians who did not. Cancer patients received good palliative practice more often than patients dying from non-malignant diseases (p < 0.05). CONCLUSION: Guideline-based palliative care for dying patients was found to be implemented more likely and consistent within the oncology department. These results point to a potential lack of training of fellows in non-oncological departments in terms of good end-of-life care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00432-021-03652-0. |
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