Palliative Approach Remains Lacking in Terminal Hospital Admissions for Chronic Disease Across Rural Settings: Multisite Retrospective Medical Record Audit

• DOI: 10.1016/j.jpainsymman.2024.02.009
• Publication Date: 2024-02-15T09:51:12Z
• Authors: Rebecca Disler; Amy Pascoe; Xinye Esther Chen; Emily Lawson; Michael Cahyadi; Ajanth Paalendra; Helen Hickson; Julian Wright; Bronwyn Phillips; Sivakumar Subrama...; Kristen Glenister; Jennifer Philip; Doranne Donesky; Natasha Smallwood
• Keywords: Medical record

Introduction/AimDespite clear benefit from palliative care in end-stage chronic diseases, access is often limited, and rural largely undescribed. This study sought to determine if a approach provided people with disease their terminal hospital admission.MethodsMultisite, retrospective medical record audit, of decedents primary diagnosis lung, heart or renal failure, multimorbidity these conditions over 2019.ResultsOf 241 decedents, across five clinical sites, 143 (59.3%) were men, mean age 80.47 years (SD 11.509), diagnoses lung (n=56, 23.2%), (n=24, 10.0%) (n=105, 43.6%), had 2.88 (3.04SD) admissions within 12 months. Outpatient was evident (n=171, 73.7%), however, contact private physician (n=91, 37.8%), program (n=61, 25.3%), specialist nurse (n=17, 7.1%) less apparent. "Not-for-resuscitation" orders common (n=139, 57.7%), advance planning (n=71, 29.5%), preferred place death (n=18, 7.9%), spiritual support 7.5%) rarely documented. Referral input services low (n=74, 30.7% n=49, 20.3%), as review non-essential medications blood tests (n=86, 35.7%, n=78, 32.4%). Opioids prescribed 45.2% (n=109). Hospital site significantly associated outpatient (p<0.001).ConclusionsEnd-of-life involvement occurred infrequently for who died hospitals. Targeted strategies are necessary improve prevalent high needs populations.