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Objective: Hospitals increasingly appoint nurse champions to improve quality of care. This study investigated the effect of palliative care nurse champions on nursing end-of-life care. Methods: Imbedded in a controlled before-after study (June 2009-July 2012) on care for the dying patient in the hospital, nurses completed questionnaires on end-of-life care within two weeks after the patient’s death. Halfway the study, seven out of 18 participating wards appointed two palliative care nurse champions. Characteristics of end-of-life care were compared for patients who died before and after the introduction of the nurse champion program and with outcomes in 11 control wards. Results: In the intervention wards, data were collected on 81 patients in the pre-intervention period and on 93 patients in the post-intervention period; in control wards these numbers were 114 and 121, respectively (response 54%). After the introduction of the nurse champion program, nurses in the intervention wards more frequently discussed imminent death with patients (35% pre-intervention vs 50% post-intervention, p=0.05), were more frequently aware of psychological symptoms (57% vs 71%, p=0.04), and performed less futile interventions during the final hours (on average 0.8 vs 0.4 out of 4 interventions, p

Introduction: Research indicates that end-of-life care in hospitals is not always optimal. Recognition of impending death by hospital physicians is a prerequisite for communication with patients and relatives about dying in hospital and providing care adequately addressing patients' needs at the end of life. We examined if hospital physicians recognized the impending death of their dying patients and if that recognition was related with more appropriate communication and care at the end of life, and with quality of dying. Methods: Post-mortem survey of hospital physicians about care in the final three days of patients who died at one of the 18 participating wards in a Dutch university hospital, between June 2009 and March 2011. Non parametric tests (e.g. ?², Mann-Whitney, ANOVA) were performed to analyse data. Results: In 79% of cases (N=228), the nearness of death was completely or partially recognized by physicians, at least six hours in advance. In 69% of recognized cases, it was recognized three days or less before death. If recognized, discussing death with patients and relatives was more likely. Change of treatment goal into comfort care or abstention and prescription of opioids were more likely if impending death was recognized. The presence of the physician at the time of death was less likely if it was recognized. According to the physician, the quality of death was better if it had been recognized in advance. Discussion: In four fifths of deaths, the impending death of their dying patients was recognized by hospital physicians of a Dutch teaching hospital. Recognition was related with more appropriate communication and care at the end of life.

OBJECTIVE: To evaluate the practice of continuous palliative sedation after the introduction of a national guideline.DESIGN: Investigation by questionnaire.METHOD: In 2008, 1580 physicians were asked to fill out a questionnaire regarding the last patient for whom they had prescribed continuous sedation until death.RESULTS: The response was 38% (n = 606). Eighty-two percent of the respondents were aware of the national guideline. Dyspnoea, pain and physical exhaustion were most often mentioned as the decisive indications for continuous sedation. The decision to use sedation was discussed with all mentally competent patients; in 18% of these cases, the patients had only been informed of the decision. Life expectancy at the start of continuous sedation was estimated to be less than 2 weeks in 97% of the cases. In 14% of the cases, the physicians felt pressured to start the sedation, predominantly by patients and relatives. Physicians were present at the start of sedation in 81% of the cases. Midazolam was used to induce sedation in 92%, and 41% of the physicians estimated that continuous sedation had hastened death to some extent. Most physicians believed that their patients' symptoms had been adequately relieved by continuous sedation, that the relatives were satisfied and that the quality of dying had been good.CONCLUSION: Continuous sedation practice in the Netherlands largely reflects the recommendations of the national guideline. Issues needing further attention are the pressure felt by physicians to start continuous sedation, as well as the possible life-shortening effect of continuous sedation as perceived by some of the physicians.

Palliative sedation is undergoing extensive debate. The aims of this study were to describe the practice of palliative sedation at a specialized acute palliative care unit and to study whether patients who received palliative sedation differed from patients who did not. We performed a systematic retrospective analysis of the medical and nursing records of all 157 cancer patients who died at the acute palliative care unit between 2001 and 2005. Palliative sedation, defined as continuous deep sedation prior to death, was used for 43% of all deceased patients. In 87% of the sedated patients, it was started in the last two days before death. Sedated and nonsedated patients did not differ in survival after admission (eight days vs. seven days, P ¼ 0.12). Sedated patients were younger (55 years vs. 59 years, P ¼ 0.04) and more often had malignancies of the digestive tract (P

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