Palliative care on Scottish surgical wards needs improving

By Sarah Guy, MedWire Reporter

More than half of individuals with terminal gastrointestinal cancer on general surgical wards in Scotland do not undergo operative intervention on their final admission, show study results published in The Surgeon.

While adverse events in these individuals were uncommon, the researchers report that a small percentage of those resulting in death occurred due to complications of interventions designed to palliate the patient.

"Satisfactory end-of-life care may never be provided to all who merit it, particularly those who deteriorate and die unexpectedly, but community-based staff must decide whether hospital referral is appropriate and once an inpatient, the standard of care should include hospital-based specialist palliative care," say Jamie Young, from Ninewells Hospital and Medical School in Dundee, Scotland, UK, and colleagues.

The team examined end-of-life care among patients dying of gastrointestinal cancer admitted to surgical wards to address the potentially unmet need for acute palliative care resources and nonoperative care in these patients.

Using data spanning 12 years, Young and team identified 8017 deaths from gastrointestinal cancer while under the care of a consultant surgeon, which equated to 15% of all hospital deaths during the period.

In all, 4350 (54%) patients - an approximate 360 per annum - died without receiving an operation or endoscopy, and just over half (57%) of these patients were documented as having received specialist palliative care, note the authors.

Although the yearly figure does not seem large, it is "greater than the combined number of patients who had esophageal and pancreatic operations for cancer in 2005," say Young et al.

The team observed adverse events in 2% of the entire population, with the most common known event relating to poor general medical care, followed by a procedural error, and then delays or failure to arrange hospice or interhospital transfer for patients.

Indeed, of patients who died without operative or endoscopic treatment, 0.4% died after receiving an intervention intended to palliate them (including rapid symptom control and intensive psychosocial care).

"Therefore there is the potential to improve end-of-life care by the use of acute palliative care units as these units may confer improved patient and family satisfaction with holistic end-of-life care over a standard acute surgical ward," conclude the researchers.

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