Programmaleider Verpleging, Verzorging en Ouderenzorg; bijzonder hoogleraar 'Verpleging en verzorging in de laatste levensfase', Vrije Universiteit / Amsterdam UMC
Publicatie
Publicatie datum
Advance Care Planning for Cancer Patients: A Retrospective Chart Review in Patients Who Died in a Dutch University Hospital.
Raijmakers, N.J.H., Fransen, H.P., Lokker, M.E., Brom, L., Heide, A. van der, Onwuteaka-Phlipsen, B.D., Janssen, D.J.A., Engles, Y, Francke, A.L., Reyners, A.K.L. Advance Care Planning for Cancer Patients: A Retrospective Chart Review in Patients Who Died in a Dutch University Hospital. European Journal of Palliative Care: 2017, p. 954. Abstract. In: Abstractbook 15th World congress of the European associationn for Palliative care: Progressing Palliative Care. 18-20 mei 2017, Madrid.
Advance care planning helps to ensure appropriate palliative care that is in line with the wishes of the patient.A minority of patients dies in a university hospital, insight into the documentation and practice of advance care planning for this high complex patient population is important.
Aims
To assess how often advance care planning and end-oflife decisions are documented for patients who die from cancer in a university hospital in the Netherlands.
Methods
A retrospective chart review was conducted within the 8 Dutch university hospitals. Data of the Dutch Cancer Registry were used to identify 150 oncological patients who died between Oct 2013 and Feb 2014. Those patients who died in the hospital due to cancer were selected. Outcome measures were derived from the patient file by trained data managers. Whether a patient was admitted to the hospital during a palliative care trajectory was retrospectively
assessed by an oncologist(AR) and a specialized nurse(ML).
Results
Data of ninety-four patients were included. Of those patients, 47% were in a palliative trajectory upon admission to the hospital. In 66 patients(87%) the approaching death was discussed during the last week of life. Do Not Resuscitate orders(DNR) were recorded in the patient file in 80% of the patients, in 33% a Do Not Treat order(DNT) was noted and in 10% an advance euthanasia directive was recorded in the file. In 18% of the patients the life expectancy was documented and in 18% the preferred place of dying was documented. For patients admitted to the hospital in a palliative care trajectory, DNR orders(93% vs. 69%, p=0.004) and DNT-orders(44% vs. 23%, p=0.035) were more often documented for patients in a curative or diagnostic trajectory.
Conclusion
Although the majority of patients were not in a palliative care trajectory, advance care planning items were recorded in patients’ files in most cases. Information on preferences regarding place of death was less often present in the patient file.
Aims
To assess how often advance care planning and end-oflife decisions are documented for patients who die from cancer in a university hospital in the Netherlands.
Methods
A retrospective chart review was conducted within the 8 Dutch university hospitals. Data of the Dutch Cancer Registry were used to identify 150 oncological patients who died between Oct 2013 and Feb 2014. Those patients who died in the hospital due to cancer were selected. Outcome measures were derived from the patient file by trained data managers. Whether a patient was admitted to the hospital during a palliative care trajectory was retrospectively
assessed by an oncologist(AR) and a specialized nurse(ML).
Results
Data of ninety-four patients were included. Of those patients, 47% were in a palliative trajectory upon admission to the hospital. In 66 patients(87%) the approaching death was discussed during the last week of life. Do Not Resuscitate orders(DNR) were recorded in the patient file in 80% of the patients, in 33% a Do Not Treat order(DNT) was noted and in 10% an advance euthanasia directive was recorded in the file. In 18% of the patients the life expectancy was documented and in 18% the preferred place of dying was documented. For patients admitted to the hospital in a palliative care trajectory, DNR orders(93% vs. 69%, p=0.004) and DNT-orders(44% vs. 23%, p=0.035) were more often documented for patients in a curative or diagnostic trajectory.
Conclusion
Although the majority of patients were not in a palliative care trajectory, advance care planning items were recorded in patients’ files in most cases. Information on preferences regarding place of death was less often present in the patient file.
Advance care planning helps to ensure appropriate palliative care that is in line with the wishes of the patient.A minority of patients dies in a university hospital, insight into the documentation and practice of advance care planning for this high complex patient population is important.
Aims
To assess how often advance care planning and end-oflife decisions are documented for patients who die from cancer in a university hospital in the Netherlands.
Methods
A retrospective chart review was conducted within the 8 Dutch university hospitals. Data of the Dutch Cancer Registry were used to identify 150 oncological patients who died between Oct 2013 and Feb 2014. Those patients who died in the hospital due to cancer were selected. Outcome measures were derived from the patient file by trained data managers. Whether a patient was admitted to the hospital during a palliative care trajectory was retrospectively
assessed by an oncologist(AR) and a specialized nurse(ML).
Results
Data of ninety-four patients were included. Of those patients, 47% were in a palliative trajectory upon admission to the hospital. In 66 patients(87%) the approaching death was discussed during the last week of life. Do Not Resuscitate orders(DNR) were recorded in the patient file in 80% of the patients, in 33% a Do Not Treat order(DNT) was noted and in 10% an advance euthanasia directive was recorded in the file. In 18% of the patients the life expectancy was documented and in 18% the preferred place of dying was documented. For patients admitted to the hospital in a palliative care trajectory, DNR orders(93% vs. 69%, p=0.004) and DNT-orders(44% vs. 23%, p=0.035) were more often documented for patients in a curative or diagnostic trajectory.
Conclusion
Although the majority of patients were not in a palliative care trajectory, advance care planning items were recorded in patients’ files in most cases. Information on preferences regarding place of death was less often present in the patient file.
Aims
To assess how often advance care planning and end-oflife decisions are documented for patients who die from cancer in a university hospital in the Netherlands.
Methods
A retrospective chart review was conducted within the 8 Dutch university hospitals. Data of the Dutch Cancer Registry were used to identify 150 oncological patients who died between Oct 2013 and Feb 2014. Those patients who died in the hospital due to cancer were selected. Outcome measures were derived from the patient file by trained data managers. Whether a patient was admitted to the hospital during a palliative care trajectory was retrospectively
assessed by an oncologist(AR) and a specialized nurse(ML).
Results
Data of ninety-four patients were included. Of those patients, 47% were in a palliative trajectory upon admission to the hospital. In 66 patients(87%) the approaching death was discussed during the last week of life. Do Not Resuscitate orders(DNR) were recorded in the patient file in 80% of the patients, in 33% a Do Not Treat order(DNT) was noted and in 10% an advance euthanasia directive was recorded in the file. In 18% of the patients the life expectancy was documented and in 18% the preferred place of dying was documented. For patients admitted to the hospital in a palliative care trajectory, DNR orders(93% vs. 69%, p=0.004) and DNT-orders(44% vs. 23%, p=0.035) were more often documented for patients in a curative or diagnostic trajectory.
Conclusion
Although the majority of patients were not in a palliative care trajectory, advance care planning items were recorded in patients’ files in most cases. Information on preferences regarding place of death was less often present in the patient file.