Language used by health care professionals to describe dying at an acute care hospital.
J Pain Symptom Manage. 2018 May 21;:
Authors: Wentlandt K, Toupin P, Novosedlik N, Le LW, Zimmermann C, Kaya E
PURPOSE: To understand the language used to describe the deterioration and death of patients in an acute academic tertiary care centre, and to identify whether patient diagnoses or palliative care(PC) involvement was associated with clearer descriptions of this process.
METHODS: We conducted a retrospective chart review of the final admission of 150 patients who died on an inpatient internal medicine unit. Conventional and summative content analysis was performed of the language used to describe, either directly or indirectly, that the patient's death was imminent.
RESULTS: Of the 150 deaths, the median age was 79.5(range22-101), 58% were male, and 69% spoke English. A total of 45% of deaths were from cancer, and 66% occurred with prior PC team involvement. There was no documentation of the dying process in 18(12%) of charts. In the remainder, clinicians' documentation of imminent death fell into three categories: 1identification of the current state using specific labels, e.g. 'dying'(24.7%), or 'end of life'(15.3%), or less specific language, 'unwell' or 'doing poorly'(6.0%); 2predicting the future state using specific or more vague predictions: e.g.'hours to days'(7.3%) or 'poor or guarded prognosis'(26.0%); 3using care provided to the patient to imply patient status: e.g. palliative care(49.3%) or comfort care(28.7%). PC involvement, but not a malignant diagnosis, was associated with more frequent use of specific language to describe the current(p=0.004) or future state(p=0.02).
CONCLUSION: Death and dying in hospital is inadequately documented and is often described using unclear and vague language. PC involvement is associated with clearer language to describe this process.
PMID: 29792980 [PubMed - as supplied by publisher]