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Patients’ dying wishes not always heard

While older patients are naturally more likely to be weighing up their end-of-life care options, a new study suggests that their wishes are not always being honoured.

Patients’ dying wishes not always heard

Most elderly people would prefer to die at home rather than in hospital, according to a new Canadian study, but apparently – that’s not the way it always works out.

Dr. Daren Heyland from Kingston General Hospital in Ontario blamed it on a lack of adequate discussion between patients and doctors, stating that this often leads to “aggressive” care at the end of life, resulting in family member stress afterwards.

“These are 80-year-old patients who are frail, sick, in hospitals, and so they’ve obviously considered their end-of-life situation,” study leader Heyland told Reuters Health.

“The real problem is the failure of the health care team to engage them.”

Another recent US study found an increase in the number of people admitted to the intensive care unit before they died between 2000 and 2009. While the use of hospice care was also increasing, dying patients were most often transferred here only in their last dying days.

The study, conducted on 278 sick and elderly patients who were in hospital and expected to live less than six months, and 225 family members.

Roughly three-quarters of the patients claimed to have thought about end-of-life care before being hospitalised, with the vast majority having discussed these wishes with a family member, rather than their doctor.

Even when patients’ wishes were noted in their medical records, two-thirds of the time, those notes differed from what patients and their family members expressed during interviews.

“That to me is a huge and alarming problem, that an 80-year-old patient says, ‘When it comes to the final stages of life, just focus on keeping me comfortable,’ and on their medical record, they’re up for full resuscitative practices,” Heyland said.

“It is important that they open their mouths and adequately communicate their wishes and request or ensure that they get documented appropriately in whatever medical record the facility has for them.”While older patients are naturally more likely to be weighing up their end-of-life care options, a new study suggests that their wishes are not always being honoured.

Most elderly people would prefer to die at home rather than in hospital, according to a new Canadian study, but apparently – that’s not the way it always works out.

Dr. Daren Heyland from Kingston General Hospital in Ontario blamed it on a lack of adequate discussion between patients and doctors, stating that this often leads to “aggressive” care at the end of life, resulting in family member stress afterwards.

“These are 80-year-old patients who are frail, sick, in hospitals, and so they’ve obviously considered their end-of-life situation,” study leader Heyland told Reuters Health.

“The real problem is the failure of the health care team to engage them.”

Another recent US study found an increase in the number of people admitted to the intensive care unit before they died between 2000 and 2009. While the use of hospice care was also increasing, dying patients were most often transferred here only in their last dying days.

The study, conducted on 278 sick and elderly patients who were in hospital and expected to live less than six months, and 225 family members.

Roughly three-quarters of the patients claimed to have thought about end-of-life care before being hospitalised, with the vast majority having discussed these wishes with a family member, rather than their doctor.

Even when patients’ wishes were noted in their medical records, two-thirds of the time, those notes differed from what patients and their family members expressed during interviews.

“That to me is a huge and alarming problem, that an 80-year-old patient says, ‘When it comes to the final stages of life, just focus on keeping me comfortable,’ and on their medical record, they’re up for full resuscitative practices,” Heyland said.

“It is important that they open their mouths and adequately communicate their wishes and request or ensure that they get documented appropriately in whatever medical record the facility has for them.”

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