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Dying in hospital: medical failure or nature outcome?

Middlewood, Sue, Gardner, Glenn and Gardner, Anne 2001, Dying in hospital: medical failure or nature outcome?, Journal of pain and symptom management, vol. 22, no. 6, pp. 1035-1041, doi: 10.1016/S0885-3924(01)00362-1.

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Title Dying in hospital: medical failure or nature outcome?
Author(s) Middlewood, Sue
Gardner, Glenn
Gardner, Anne
Journal name Journal of pain and symptom management
Volume number 22
Issue number 6
Start page 1035
End page 1041
Publisher Elsevier Inc.
Place of publication New York, N.Y.
Publication date 2001
ISSN 0885-3924
1873-6513
Keyword(s) terminal care
end-of-life decisions
dying in hospital
Summary The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.
Notes Available online 29 November 2001.
Language eng
DOI 10.1016/S0885-3924(01)00362-1
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2001, U.S. Cancer Pain Relief Committee
Persistent URL http://hdl.handle.net/10536/DRO/DU:30006579

Document type: Journal Article
Collection: School of Exercise and Nutrition Sciences
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