Quality of dying—how are we doing?
- Professor Roderick D MacLeod, Goodfellow Unit, Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand; rd.macleod{at}auckland.ac.nz
Most people, when given a choice, would choose to die at home, however, the reality is that many of us will die in hospital. How that death will be, is often a cause for debate and, for some, concern.
The Study to Understand Progress and Preferences for Outcome and Risks of Treatment (SUPPORT)1 is one of many studies that showed much was at fault with the way end-of-life care was provided in hospitals. Of the hospitalised patients in that study, 50% experienced moderate to severe pain during the last 3 days of life; fewer than half of doctors discussed cardiopulmonary resuscitation with their patients, and almost half of the do not resuscitate (DNR) orders were written within 2 days of death.
It may be that the studies referred to above were undertaken some time ago, but there is still evidence to suggest that more needs to be done. Pain and symptom management have been reported as main concerns for the dying patient and their relatives.23 Patients report psychological symptoms4 and difficulties in communication.5 Even when treatment options are discussed, often patients do not understand their options.67
It is especially heartening therefore, to see a study in this issue of …
