Dignified Death Still Elusive On Many Cancer Wards

MedicalResearch.com Interview with:
Karin Jors MA
Department of Palliative Care, Comprehensive Cancer Center,
University Medical Center Freiburg, Freiburg, Germany

Medical Research: What are the main findings of the study?

Answer: The findings of our study shed light on the current circumstances for dying in cancer centers. Physicians and nurses in our study reported that they rarely have enough time to care for dying patients. In addition, only a minority of staff members felt that they had been well-prepared during their training to care for dying patients and their families. Overall, only 56% of participants indicated that it is usually possible for patients to die in dignity on their ward. This is likely the result of various factors such as: inadequate rooms for dying patients and their families (i.e. shared rooms), poor communication with patients regarding burdensome treatments, an overuse of life-prolonging measures, etc. Striking differences were found between the responses of palliative care staff and staff from other wards (e.g. general care, oncology, intensive care). For example, palliative care staff reported that they usually have enough time to care for dying patients. In addition, 95% of palliative care staff indicated that it is usually possible for patients to die in dignity on their ward. Overall, nurses perceived the situation for dying patients more negatively than physicians. Whereas 72% of physicians reported that patients can usually die a dignified death on their ward, only 52% of nurses shared this opinion. Although only slightly more than half of participants believed that patients can usually die in dignity on their ward, this is a considerable improvement to the situation 25 years ago. In a similar study published in 1989, researchers found that 72% of physicians and nurses experienced the situation for patients dying on their hospital ward as undignified.

 Medical Research: What should clinicians and patients take away from your report?

Answer: Over the last 25 years, considerable improvements in the care of patients dying in the hospital setting have taken place. Patients can be comforted by the knowledge that the overwhelming majority of physicians and nurses in our study recognized the importance of honestly informing patients about their prognosis as well as all potential treatment options, even potentially burdensome ones. This stands in contrast to the study from 25 years ago, which found that 58% of physicians and nurses believed that patients did not wish to be informed about their prognosis, and 54% from the prior study were of the opinion that knowledge of a negative prognosis could be harmful to the patient. Furthermore, it can be viewed positively that the majority of physicians and nurses in our study expressed a desire for more training in end-of-life care, which suggests that they recognize the importance of this aspect of their work.

The results of this study also have important implications for practicing physicians and nurses. Our study found that 72% of physicians believe it is usually possible for patients to die a dignified death on their ward, but only 52% of nurses shared this opinion. This difference in perception suggests that physicians and nurses may need to communicate more effectively with each other about the needs of dying patients in order to provide the best possible care. According to our results, physicians and nurses on palliative care wards work together more closely, and this appears to correspond with an overall more positive experience for dying patients. A majority of participants in this study also complained that they rarely have enough time to care for dying patients. Working in a team may also help to alleviate this burden by distributing responsibility among several people.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: Although we aimed at a comprehensive investigation of the situation for patients dying in cancer centers, there are still other issues that should be explored, such as the role of other health care professionals including psychologists, social workers and chaplains.

Our findings indicate that future research should be conducted to establish feasible, patient-oriented standards for end-of-life care. In addition, further research is necessary to develop comprehensive palliative care curricula and training for health care staff. To encourage such research, the Palliative Care Center of Excellence in Baden-Württemberg (KOMPACT) was established in 2014. This center combines the expertise of five academic, specialist palliative care departments. We believe that this cooperation is a valuable tool for improving patient care in the end-of-life setting.

Citation: 

Dying in cancer centers: Do the circumstances allow for a dignified death?

Jors, K., Adami, S., Xander, C., Meffert, C., Gaertner, J., Bardenheuer, H., Buchheidt, D., Mayer-Steinacker, R., Viehrig, M., George, W. and Becker, G. (2014), Dying in cancer centers: Do the circumstances allow for a dignified death?. Cancer. doi: 10.1002/cncr.28702