Professional Practice Assessment: Improving End-of-Life Care Through the Standardization of Treatment Limitation in the Long-Term Care Facilities of a French Hospital.

Abstract

Background: Palliative support has been shown to improve the quality of end-of-life care provided in long-term care facilities (LTCF). In this context, a practice improvement plan, which included creating a withholding and withdrawing life-sustaining treatment (WLST) protocol, has been developed and implemented in our LTCF. We aimed to compare professional practices before and after the implementation of this improvement plan. Methods: The study population included all individuals who died in 2018 and in 2021. A clinical audit noted if WLST was decided and which palliative interventions were deployed. Results: WLST decisions were significantly more frequently taken in 2021 than in 2018, with a longer interval between the decisions and death, as well as fewer transfers to acute care facilities. Conclusions: Identifying and managing end-of-life situations more frequently leads to shared WLST decisions, which allow for more effective cessation of interventions and fewer transfers during the last month of life.