Who needs a hospice?

Abstract

Objective: Rapid evolution of palliative care programs in Australia over recent years has brought the role of traditional inpatient hospices under review. This study attempts to define the clinical characteristics of patients referred for inpatient palliative care.

Design: A retrospective chart survey was performed of 432 consecutively referred patients.

Setting: The study was undertaken in a 60-bed hospice providing intensive nursing and medical care to patients with terminal illness.

Outcome measures: Demographic characteristics, diagnosis, length of stay, outcome and use of analgesics are presented. Patients not using regular analgesia at admission were studied to determine their major symptom complexes and their use of medication.

Results: Public hospitals referred 67.6% of patients and 25% came from home. While 83.8% of patients died in hospice care, 16.2% were discharged, usually to home or a nursing home. At admission, 16.9% of patients could walk unassisted, 20.6% were chair-bound and 62.5% were bed-bound. The median length of stay in the hospice was 16 days. Ambulant status, female sex, non-use of opioids and a diagnosis of brain or breast cancer were all associated with longer stay. At admission, 39.1% of patients were taking potent opioids regularly, 22.9% were taking mild analgesics and 38.0% were taking no regular analgesia. Of those taking no analgesia, cachexia (55.9%), confusion (35.4%), impaired conscious state (19.9%) and impaired motor neurological function (21.7%) were the major clinical problems.

Conclusions: The data show that patients selected for hospice care were highly dependent, with major functional impairments and short life expectancy. The medical, social and economic implications of these findings are discussed.