End-of-life care in acute hospitals: an integrative literature review

Aim. To explore and define the current status of published literature related to end-of-life care in the acute hospital setting.
Background. Chronic illness is now the leading cause of death in developed countries because the population is and the advances in health care delivery. In Australia, two-third of people with chronic illness who die is inpatient in an acute hospital. Whilst most of the attention regarding end-of-life care and dying has focused on palliative care settings, there is a need to consider those dying outside of specialist palliative care settings.
Design. Integrative literature review.
Methods. Using an integrative approach, electronic searches of selected databases were undertaken, using comprehensive search terms. Secondary sources were also identified through the reference lists of retrieved literature.
Results. The literature review identified a lack of high-quality scientific evidence to direct end-of-life care as delivered in the acute (non-palliative care) sector. From the literature available, five core themes/issues were generated to reflect the literature.
Conclusions. There is a need for research to investigate end-of-life care in the acute hospital setting. Care pathways are in use to varying degrees without validation, but implementation alone does not ensure quality end-of-life care. Cultural factors can impede/impact practice and the ability of clinicians to recognise ‘active dying’ has been shown to be problematic, delaying the transition to end-of-life care.
Relevance to clinical practice. Given that the majority of deaths in Australia occur in acute hospital settings, clinicians should be delivering expert life-sustaining acute care and also quality end-of-life care.