Blog | Wednesday, July 11, 2012

QD: News Every Day--Meet comfort, spiritual needs for best end-of-life care


Attending to a comfortable environment and spiritual needs explain the biggest variances in quality of care at the end of life, a study found.

Advanced cancer patients who avoid hospitalizations and the intensive care unit (ICU), who are less worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest quality of life at the end of life, researchers reported.

They used results from Coping With Cancer, a U.S. multisite, prospective, longitudinal cohort study of 396 advanced cancer patients and their informal caregivers who were enrolled from September 2002 through February 2008. Patients were followed up from enrollment to death a median of 4.1 months later.

http://archinte.jamanetwork.com/article.aspx?articleid=1212631
Nine factors explained the most variance (plus or minus, in absolute value) in patients' quality of life at the end of life:
--(−) intensive care unit stays in the final week (4.4%),
--(−) hospital deaths (2.7%),
--(−) patient worry at baseline (2.7%),
--(+) religious prayer or meditation at baseline (2.5%),
--site of cancer care (1.8%),
--(−) feeding-tube use in the final week (1.1%),
--(+) pastoral care within the hospital or clinic (1.0%),
--(−) chemotherapy in the final week (0.8%), and
--(+) patient-physician therapeutic alliance at baseline (0.7%).

Receipt of any life-prolonging procedure in the last week and an ICU stay predicted significantly worse quality of life. Deaths in the ICU and hospital were associated with significantly worse quality, whereas deaths at home were associated with significantly better quality.

That authors wrote, "Two of the most important determinants of poor patient QOL (quality of life) at the EOL (end of life) were dying in a hospital and ICU stays in the last week of life. Therefore, attempts to avoid costlyhospitalizations and to encourage transfer of hospitalized patients to home or hospice might improve patient QOL at the EOL."