Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1994 Sep 3;309(6954):583–586. doi: 10.1136/bmj.309.6954.583

Care of dying patients in hospital.

M Mills 1, H T Davies 1, W A Macrae 1
PMCID: PMC2541438  PMID: 8086948

Abstract

OBJECTIVE--To study the process of care of dying patients in general hospitals. DESIGN--Non-participant observer (MM) carried out regular periods of continuous comprehensive observation in wards where there were dying patients, recording the quantity and quality of care given. Observations were made in 1983. SETTING--13 wards (six surgical, six medical, and one specialist unit) in four large teaching hospitals (bed capacity 504-796) in west of Scotland. SUBJECTS--50 dying patients (29 female, 21 male) with mean age of 66 (range 40-89); 29 were dying from cancer and 21 from non-malignant disease. RESULTS--Final period of hospitalisation ranged from 6 hours to 24 weeks. More than half of all patients retained consciousness until shortly before death. Basic interventions to maintain patients' comfort were often not provided: oral hygiene was often poor, thirst remained unquenched, and little assistance was given to encourage eating. Contact between nurses and the dying patients was minimal; distancing and isolation of patients by most medical and nursing staff were evident; this isolation increased as death approached. CONCLUSIONS--Care of many of the dying patients observed in these hospitals was poor. We need to identify and implement practical steps to facilitate high quality care of the dying. Much can be learned from the hospice movement, but such knowledge and skills must be replicated in all settings.

Full text

PDF
583

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bowling A. The hospitalisation of death: should more people die at home? J Med Ethics. 1983 Sep;9(3):158–161. doi: 10.1136/jme.9.3.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Buckingham R. W., 3rd, Lack S. A., Mount B. M., MacLean L. D., Collins J. T. Living with the dying: use of the technique of participant observation. Can Med Assoc J. 1976 Dec 18;115(12):1211–1215. [PMC free article] [PubMed] [Google Scholar]
  3. Cameron J., Parkes C. M. Terminal care: evaluation of effects on surviving family of care before and after bereavement. Postgrad Med J. 1983 Feb;59(688):73–78. doi: 10.1136/pgmj.59.688.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Conboy-Hill S. Psychosocial aspects of terminal care. A preliminary study of nurses' attitudes and behaviour in a general hospital. Int Nurs Rev. 1986 Jan-Feb;33(1):19–21. [PubMed] [Google Scholar]
  5. Higginson I., McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled? J R Soc Med. 1989 May;82(5):264–267. doi: 10.1177/014107688908200507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Higginson I., Wade A., McCarthy M. Palliative care: views of patients and their families. BMJ. 1990 Aug 4;301(6746):277–281. doi: 10.1136/bmj.301.6746.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hinton J. Comparison of places and policies for terminal care. Lancet. 1979 Jan 6;1(8106):29–32. doi: 10.1016/s0140-6736(79)90467-7. [DOI] [PubMed] [Google Scholar]
  8. Hockley J. M., Dunlop R., Davies R. J. Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J (Clin Res Ed) 1988 Jun 18;296(6638):1715–1717. doi: 10.1136/bmj.296.6638.1715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kane R. L., Wales J., Bernstein L., Leibowitz A., Kaplan S. A randomised controlled trial of hospice care. Lancet. 1984 Apr 21;1(8382):890–894. doi: 10.1016/s0140-6736(84)91349-7. [DOI] [PubMed] [Google Scholar]
  10. Maguire P. Barriers to psychological care of the dying. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1711–1713. doi: 10.1136/bmj.291.6510.1711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Parkes C. M., Parkes J. 'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses. Postgrad Med J. 1984 Feb;60(700):120–124. doi: 10.1136/pgmj.60.700.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Proctor S. J. Why clinical research needs medical audit. Qual Health Care. 1993 Mar;2(1):1–2. doi: 10.1136/qshc.2.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Samarel N. Caring for the living and dying: a study of role transition. Int J Nurs Stud. 1989;26(4):313–326. doi: 10.1016/0020-7489(89)90018-7. [DOI] [PubMed] [Google Scholar]
  14. Seale C. A comparison of hospice and conventional care. Soc Sci Med. 1991;32(2):147–152. doi: 10.1016/0277-9536(91)90054-g. [DOI] [PubMed] [Google Scholar]
  15. Townsend J., Frank A. O., Fermont D., Dyer S., Karran O., Walgrove A., Piper M. Terminal cancer care and patients' preference for place of death: a prospective study. BMJ. 1990 Sep 1;301(6749):415–417. doi: 10.1136/bmj.301.6749.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ventafridda V., Ripamonti C., De Conno F., Tamburini M., Cassileth B. R. Symptom prevalence and control during cancer patients' last days of life. J Palliat Care. 1990 Autumn;6(3):7–11. [PubMed] [Google Scholar]
  17. Ventafridda V., Tamburini M., Caraceni A., De Conno F., Naldi F. A validation study of the WHO method for cancer pain relief. Cancer. 1987 Feb 15;59(4):850–856. doi: 10.1002/1097-0142(19870215)59:4<850::aid-cncr2820590432>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  18. Webster M. E. Communicating with dying patients. Nurs Times. 1981 Jun 4;77(23):999–1002. [PubMed] [Google Scholar]
  19. Wilkes E. Dying now. Lancet. 1984 Apr 28;1(8383):950–952. doi: 10.1016/s0140-6736(84)92400-0. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES