Quality of end-of-life care for non-cancer patients in a non-acute hospital

Authors

  • Jean Woo,

    1. Authors: Jean Woo, MD, Professor of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Raymond Lo, MD, Consultant, Palliative Care Unit & Department of Medicine and Geriatrics, Shatin Hospital; Joanna OY Cheng, MSc, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Florens Wong, BA, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Benise Mak, PhD, Research Assistant Professor, Cadenza: A Jockey Club Initiative for Seniors, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
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  • Raymond Lo,

    1. Authors: Jean Woo, MD, Professor of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Raymond Lo, MD, Consultant, Palliative Care Unit & Department of Medicine and Geriatrics, Shatin Hospital; Joanna OY Cheng, MSc, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Florens Wong, BA, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Benise Mak, PhD, Research Assistant Professor, Cadenza: A Jockey Club Initiative for Seniors, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
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  • Joanna OY Cheng,

    1. Authors: Jean Woo, MD, Professor of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Raymond Lo, MD, Consultant, Palliative Care Unit & Department of Medicine and Geriatrics, Shatin Hospital; Joanna OY Cheng, MSc, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Florens Wong, BA, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Benise Mak, PhD, Research Assistant Professor, Cadenza: A Jockey Club Initiative for Seniors, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
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  • Florens Wong,

    1. Authors: Jean Woo, MD, Professor of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Raymond Lo, MD, Consultant, Palliative Care Unit & Department of Medicine and Geriatrics, Shatin Hospital; Joanna OY Cheng, MSc, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Florens Wong, BA, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Benise Mak, PhD, Research Assistant Professor, Cadenza: A Jockey Club Initiative for Seniors, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
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  • Benise Mak

    1. Authors: Jean Woo, MD, Professor of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Raymond Lo, MD, Consultant, Palliative Care Unit & Department of Medicine and Geriatrics, Shatin Hospital; Joanna OY Cheng, MSc, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Florens Wong, BA, Research Assistant, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Benise Mak, PhD, Research Assistant Professor, Cadenza: A Jockey Club Initiative for Seniors, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
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Jean Woo, Professor, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, 9/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China. Telephone: 2632 3493.
E-mail:jeanwoowong@cuhk.edu.hk

Abstract

Aims and objectives.  Few surveys have been carried out documenting the quality of life for non-cancer patients in general district hospitals reaching the final trajectory towards death. We carried out a survey of 80 patients facing the final stages of their chronic illness as well as their carers and hospital staff.

Background.  With increasing life expectancy, a large majority of patients are older, where palliative care principles for patients with cancer are equally applicable. Few surveys have been carried out documenting the quality of life for non-cancer patients in general district hospitals reaching the final trajectory towards death in terms of patients’ and carers’ perspective, compared with the more extensive literature for patients with cancer.

Design.  Survey.

Methods.  Assessment tools include symptom check list, geriatric depression scale, Chinese Death Anxiety Inventory and the McGill Quality of Life Questionnaire for patients; SF-12 and the Chinese cost of care index for informal carers; and the Chinese Maslach Bumout and Death Anxiety Inventories for hospital staff.

Results.  Lower-limb weakness (92·5%), fatigue (86·2%), oedema (85%), dysphagia (58·2%) and pain (48·8%) were the most common symptoms in this group of patients. The mean Chinese Caregiver Stress Index score was 45·93 (SD 6·45) (maximum score = 80). For staff, the mean SF-12 physical component score was lower than the Hong Kong population average.

Conclusion.  The findings suggest that there is room for improvement in the quality of end-of-life care.

Relevance to clinical practice.  Patients in the final stages of many chronic illnesses have high prevalence of symptoms comparable to those of patients with cancer. Raising awareness and improving training for all health care professionals, formulating guidelines and care pathways and incorporating quality of care as key performance indicators are measures to improve the quality of end-of-life care.

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