TY - JOUR
T1 - Non-beneficial treatments in hospital at the end of life
T2 - A systematic review on extent of the problem
AU - Cardona-Morrell, Magnolia
AU - Kim, J. C.H.
AU - Turner, R. M.
AU - Anstey, M.
AU - Mitchell, I. A.
AU - Hillman, K.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84991786859&partnerID=8YFLogxK
U2 - 10.1093/intqhc/mzw060
DO - 10.1093/intqhc/mzw060
M3 - Article
C2 - 27353273
AN - SCOPUS:84991786859
SN - 1353-4505
VL - 28
SP - 456
EP - 469
JO - International Journal for Quality in Health Care
JF - International Journal for Quality in Health Care
IS - 4
M1 - mzw060
ER -