Evaluation of the Acute Basic Palliation Concept by Relatives and Health Care Professionals: An Observational Study of 40 Home-Dying Patients in Denmark.

Abstract

Background: Many individuals prefer to pass away in the comfort of their own homes, yet logistical obstacles often result in their admission to hospitals for end-of-life care. Objectives: To measure the effectiveness, as assessed by relatives and staff, of end-of-life care according to the acute basic palliation concept (ABPC) for patients discharged from an emergency department. Methods: An observational study of 40 consecutive actively dying patients who were discharged from Aalborg University Hospital, Denmark, using the ABPC. Effectiveness of end-of-life care was measured by questionnaires to relatives, discharging doctors and nurses, and municipality health staff. The ABPC comprised a physician checklist, instructions for medical professionals, a medication template to be personalized, an added standardized text to discharge papers, information pamphlets for patients and relatives, and a box of medicine and utensils. Results: Among the 40 included patients (mean age 84, standard deviation [SD] 7.7), four experienced improvements at home and resumed active treatment. The patients who died had an average survival time of 3.8 days (SD 7.5). According to relatives, 90% of patients died a dignified death without suffering. Municipality nurses rated the usefulness of the ABPC at 96 (interquartile range 88; 100) on a 0-100 scale, and all health care staff wanted to use the ABPC again. Conclusion: The ABPC showed great potential as a tool for discharging dying patients without specialized palliative needs to good-quality end-of-life care at home. The ABPC was widely accepted by relatives and all health staff. The ABCP is ready for large-scale testing with patient subgroups and economic analysis.