Better care for dying patients needed
About 50% of adults experience pain in the last two days of life, according to a study published in the June 27 issue of Archives of Internal Medicine. The findings suggest that new guidelines should be developed to address the needs of dying patients.1
Guidelines should anticipate the psychological, emotional, and spiritual needs that might arise for both the patient and family, says lead researcher Sarah Goodlin, MD, at Dartmouth Medical School in Hanover, NH.
"There is almost never a plan of care to address patients near the end of life. The care often reflects what one would receive if they were going to get well and go home," says Goodlin. For example, nurses may take vital signs and weigh dying patients even when the actions are uncomfortable for the patient.
Nearly half had comfort-measure only orders
The results - taken from the medical records of 104 deceased patients at two hospitals - show that 46% of patients felt some pain and 51% experienced restlessness and difficulty breathing in the last two days of life. Nearly half had a documented order for comfort measures only, and almost all had a do-not-resuscitate order. Patients with the comfort measure only order, however, had similar levels of pain as those without the order.
Reference
1. Goodlin S, Winzelberg G, Teno J, et al. Death in the Hospital, Arch Intern Med 1998; 158:1,570-1,572. n
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