Palliative Care Comes Too Late for Patients at Terminal
In a study published in the Journal of Palliative
Medicine, Fannie Gaston-Johansson, a professor in the
Johns Hopkins School
of Nursing, and researchers at Goteborg University,
Sweden, determined through a review of Swedish patient
death records that in 70 percent of cases health care
providers documented a "turning point, reflecting
identification of dying and re-orientation [of] care."
In the majority of cases recording a turning point, 53
percent were written into the case records very close to
the time of actual dying, 20 percent on the day of death
and 33 percent between two and seven days before death
The authors propose that the lack of a turning point,
or its delay until very close to death, may mean that
individuals die with unnecessary pain and distress due to
invasive and ineffective therapies.
Gaston-Johansson and colleagues also found that both
deterioration of an individual's condition and sporadic
confinement to bed were strongly associated with the
presence of a documented turning point, making the
probability of such a turning point 94 percent when both
signs were present. The indicators were not related to
specific chronic conditions or causes of death but may be
particularly relevant to cardiovascular disease, where the
commonly held belief is that the life expectancy of
patients is difficult to estimate.
The authors conclude that "with most of the
individuals in the study, the turning point is not adequate
time to start palliative care, since it is usually too
late. Palliative care should start gradually from the time
of an incurable life-threatening disease and broaden its
scope toward the terminal phase of the illness."
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