PHYSICIANS PRACTICES AND END OF LIFE

Purpose: The numbers of people who spend their last months of their life in nursing homes and hospices are increasing rapidly. The percentage of older people who received hospice care in the last 30 days of life increased from 19 percent in 1999 to 43 percent in 2009. The percentage of older Americans who died in hospitals dropped from 49 percent in 1999 to 32 percent in 2009. The percentage that died at home increased from 15 percent in 1999 to 24 percent in 2009. This increase in hospice care requires more consideration of palliative care and end of life (EOL) decisions. Physicians often play a role in EOL of their patients in the nursing home setting, and are integral in discussing EOL decision related to care. Thus more research is needed to understand the clinician’s perceptions of spirituality and what constitutes a good death. The goal of this study was to assess healthcare providers' practices that influence end of life care in the nursing home and identify those factors that are associated with what practitioners deem to be a "good death." Methods: A group of 57 healthcare providers working in nursing homes in the United States completed surveys on the end of life experiences of 259 patients. A brief anonymous survey including both open- and closed-ended questions assessed the provider’s practices and perceptions of end of life practices of up to 10 of their patients that had just died. The survey included the demographics of healthcare providers, patients, and institutions. There were also questions regarding the availability of services (e.g., hospice care) within the nursing home and practice patterns of providers and institutions. Lastly, respondents were asked if they felt their patient(s) experienced a "good death." Results: The majority of the surveys were completed by Physicians (90%), and the rest were completed by Physicians Assistants or Nurse Practitioners. Most facilities (35%) surveyed contained between 100-150 patient beds, and over 85% of the patients died in the nursing home facility, with only 10% dying at the hospitals. The provider felt that over 49% of the patients spiritual needs were met, 10% did not feel needs were met, 20% responded NA, and the rest felt they were unsure due to advanced dementia of the patient. Lastly, 77% of providers felt the patient experienced a “good death”, and 13% (34) did not feel the patient had a good death. The most common attributes associated with a good death were pain free, family present, and sudden or peaceful death. Severe pain or patients uncomfortable were most commonly reported for a “bad death.” Conclusion: With continuing advances in medical technology, pharmaceuticals, and aging research, the elderly population of the United States is growing. To that end, it is important for providers to be prepared to address issues related to EOL decisions. A provider’s personal practices, perception and help in transitioning patients at the end of life are important factors to understand so that more patients can experience a good death.