TY - JOUR
T1 - Potentially Inappropriate Treatments at the End of Life in Nursing Home Residents
T2 - Findings From the PACE Cross-Sectional Study in Six European Countries
AU - Honinx, Elisabeth
AU - Van den Block, Lieve
AU - Piers, Ruth
AU - Van Kuijk, Sander M.J.
AU - Onwuteaka-Philipsen, Bregje D.
AU - Payne, Sheila A.
AU - Szczerbińska, Katarzyna
AU - Gambassi, Giovanni G.
AU - Finne-Soveri, Harriet
AU - Deliens, Luc
AU - Smets, Tinne
AU - Gatsolaeva, Yuliana
AU - Miranda, Rose
AU - Pivodic, Lara
AU - Tanghe, Marc
AU - van Hout, Hein
AU - Van Den Noortgate, Nele
AU - Froggatt, Katherine
AU - Pasman, H. Roeline W.
AU - Baranska, Ilona
AU - Oosterveld-Vlug, Mariska
AU - Wichmann, Anne B.
AU - Engels, Yvonne
AU - Vernooij-Dassen, Myrra
AU - Hockley, Jo
AU - Leppäaho, Suvi
AU - Pautex, Sophie
AU - Bassal, Catherine
AU - Mammarella, Federica
AU - Mercuri, Martina
AU - Rossi, Paola
AU - Segat, Ivan
AU - Stodolska, Agata
AU - Adang, Eddy
AU - Kylänen, Marika
AU - Andreasen, Paula
AU - Kuitunen-Kaija, Outi
AU - Moore, Danni Collingridge
AU - Pac, Agnieszka
AU - Kijowska, Violetta
AU - Ten Koppel, Maud
AU - van der Steen, Jenny T.
AU - de Paula, Emilie Morgan
N1 - Funding Information: The authors thank all participating physicians, nurses, patients, and their families for providing data for this study and Jane Ruthven for her language editing. Miss Honinx reports funding from Polish Ministry of Science and Higher Education based on the decision no 3202/7PR/2014/2, grants from European Union's Seventh Framework Programme (FP7/ 2007e2013), during the conduct of the study. Ethics approval and consent to participate: Ethics approval from the relevant ethics committees were obtained from all participating countries. Belgium: CommissieMedischeEthiek UZBrussel, 27/05/2015; England NHS ? NRES Committee North West-Haydock, 10/09/2015; Finland: Terveydenjahyvinvoinnin laitos, Institutet f?r h?lsa och v?lf?rd, 30/6/2015; Italy: Comitato Etico, Universita Cattolica del SacroCuore, 6/11/2017; Netherlands: MedischEthischeToetsingscommissie VUMedisch Centrum, 2/7/2015; Poland: KomisjaBioetycza, UniwersytetuJagiellonskiego, 25/6/2015; Switzerland: Commission cantonale d??thique de la recherch?scientifiquede Gen?ve (CCER), 6/8/2015. All persons participating in the study (facility managers, care staff, GPs) have to give their prior informed consent in writing. If residents are unable to give informed consent, they will not be involved in the study. In some countries, such as Poland and The Netherlands, a separate informed consent is not required if questionnaires are filled in anonymously. Funding: Project has been co-funded by Polish Ministry of Science and Higher Education in the years 2014?2019 based on the decision no 3202/7PR/2014/2 dated on Nov. 25th, 2014. This work was supported by the European Union's Seventh Framework Programme (FP7/2007e2013) under grant agreement 603111(PACE project Palliative Care for Older People). The funders had no role in study design, collection, analysis or interpretation of the data, nor in writing and the decision to submit this article for publication. The authors declare that they have no competing interests. Availability of data and material: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Funding Information: Miss Honinx reports funding from Polish Ministry of Science and Higher Education based on the decision no 3202/7PR/2014/2, grants from European Union's Seventh Framework Programme (FP7/ 2007e2013), during the conduct of the study. Publisher Copyright: © 2020 American Academy of Hospice and Palliative Medicine
PY - 2021/4
Y1 - 2021/4
N2 - Context: Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives: To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods: A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results: We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion: Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.
AB - Context: Certain treatments are potentially inappropriate when administered to nursing homes residents at the end of life and should be carefully considered. An international comparison of potentially inappropriate treatments allows insight into common issues and country-specific challenges of end-of-life care in nursing homes and helps direct health-care policy in this area. Objectives: To estimate the prevalence of potentially inappropriate treatments in the last week of life in nursing home residents and analyze the differences in prevalence between countries. Methods: A cross-sectional study of deceased residents in nursing homes (2015) in six European countries: Belgium (Flanders), England, Finland, Italy, The Netherlands, and Poland. Potentially inappropriate treatments included enteral administration of nutrition, parental administration of nutrition, artificial fluids, resuscitation, artificial ventilation, blood transfusion, chemotherapy/radiotherapy, dialysis, surgery, antibiotics, statins, antidiabetics, new oral anticoagulants. Nurses were questioned about whether these treatments were administered in the last week of life. Results: We included 1384 deceased residents from 322 nursing homes. In most countries, potentially inappropriate treatments were rarely used, with a maximum of 18.3% of residents receiving at least one treatment in Poland. Exceptions were antibiotics in all countries (between 11.3% in Belgium and 45% in Poland), artificial nutrition and hydration in Poland (54.3%) and Italy (41%) and antidiabetics in Poland (19.7%). Conclusion: Although the prevalence of potentially inappropriate treatments in the last week of life was generally low, antibiotics were frequently prescribed in all countries. In Poland and Italy, the prevalence of artificial administration of food/fluids in the last week of life was high, possibly reflecting country differences in legislation, care organization and culture, and the palliative care competences of staff.
KW - End-of-life care
KW - Europe
KW - Nursing homes
KW - Potentially inappropriate treatments
UR - http://www.scopus.com/inward/record.url?scp=85092083496&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jpainsymman.2020.09.001
DO - https://doi.org/10.1016/j.jpainsymman.2020.09.001
M3 - Article
C2 - 32916262
SN - 0885-3924
VL - 61
SP - 732-742.e1
JO - Journal of Pain and Symptom Management
JF - Journal of Pain and Symptom Management
IS - 4
ER -