Non-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem

Magnolia Cardona-Morrell, J. C.H. Kim, R. M. Turner, M. Anstey, I. A. Mitchell, K. Hillman

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Abstract

Purpose: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care.Data sources: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015).Study selection: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL).Data extraction: A 13-item quality score estimated independently by two authors.Results of data synthesis: Evidence from 38 studies indicates that on average 33-38% of patients near the EOL received NBTs. Mean prevalence of resuscitation attempts for advanced stage patients was 28% (range 11-90%). Mean death in intensive care unit (ICU) was 42% (range 11-90%); and mean death rate in a hospital ward was 44.5% (range 29-60%). Mean prevalence of active measures including dialysis, radiotherapy, transfusions and life support treatment to terminal patient was 7-77% (mean 30%). Non-beneficial administration of antibiotics, cardiovascular, digestive and endocrine treatments to dying patients occurred in 11-75% (mean 38%). Non-beneficial tests were performed on 33-50% of patients with do-not-resuscitate orders. From meta-analyses, the pooled prevalence of non-beneficial ICU admission was 10% (95% CI 0-33%); for chemotherapy in the last six weeks of life was 33% (95% CI 24-41%).Conclusion: This review has confirmed widespread use of NBTs at the EOL in acute hospitals. While a certain level of NBT is inevitable, its extent, variation and justification need further scrutiny.

Original languageEnglish
Article numbermzw060
Pages (from-to)456-469
Number of pages14
JournalInternational Journal for Quality in Health Care
Volume28
Issue number4
DOIs
Publication statusPublished - 1 Sep 2016
Externally publishedYes

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Therapeutics
Intensive Care Units
Resuscitation Orders
Literature
Information Storage and Retrieval
PubMed
Resuscitation
Libraries
Publications
Meta-Analysis
Dialysis
Language
Radiotherapy
Anti-Bacterial Agents
Drug Therapy
Mortality

Cite this

Cardona-Morrell, Magnolia ; Kim, J. C.H. ; Turner, R. M. ; Anstey, M. ; Mitchell, I. A. ; Hillman, K. / Non-beneficial treatments in hospital at the end of life : A systematic review on extent of the problem. In: International Journal for Quality in Health Care. 2016 ; Vol. 28, No. 4. pp. 456-469.
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abstract = "Purpose: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care.Data sources: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015).Study selection: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL).Data extraction: A 13-item quality score estimated independently by two authors.Results of data synthesis: Evidence from 38 studies indicates that on average 33-38{\%} of patients near the EOL received NBTs. Mean prevalence of resuscitation attempts for advanced stage patients was 28{\%} (range 11-90{\%}). Mean death in intensive care unit (ICU) was 42{\%} (range 11-90{\%}); and mean death rate in a hospital ward was 44.5{\%} (range 29-60{\%}). Mean prevalence of active measures including dialysis, radiotherapy, transfusions and life support treatment to terminal patient was 7-77{\%} (mean 30{\%}). Non-beneficial administration of antibiotics, cardiovascular, digestive and endocrine treatments to dying patients occurred in 11-75{\%} (mean 38{\%}). Non-beneficial tests were performed on 33-50{\%} of patients with do-not-resuscitate orders. From meta-analyses, the pooled prevalence of non-beneficial ICU admission was 10{\%} (95{\%} CI 0-33{\%}); for chemotherapy in the last six weeks of life was 33{\%} (95{\%} CI 24-41{\%}).Conclusion: This review has confirmed widespread use of NBTs at the EOL in acute hospitals. While a certain level of NBT is inevitable, its extent, variation and justification need further scrutiny.",
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Non-beneficial treatments in hospital at the end of life : A systematic review on extent of the problem. / Cardona-Morrell, Magnolia; Kim, J. C.H.; Turner, R. M.; Anstey, M.; Mitchell, I. A.; Hillman, K.

In: International Journal for Quality in Health Care, Vol. 28, No. 4, mzw060, 01.09.2016, p. 456-469.

Research output: Contribution to journalArticleResearchpeer-review

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