Dying With Dyspnea in the Hospital

Abstract

Background: While many patients hope to die at home, many die in hospitals. Patients die with unrecognized and untreated symptoms including dyspnea.

Objective: We sought to determine prevalence of dyspnea at end of life in patients dying in acute hospital care and examine treatment patterns.

Design/participants: A retrospective chart review of deaths at tertiary care hospital over a 3-month period evaluated dyspnea in last 24 hours of life, opioid orders and administration as well as presence of palliative care consultation.

Results: Of 106 decedents, 88 experienced dyspnea or tachypnea in last 24 hours of life. Health care providers noted only 50% as dyspneic, even those undergoing terminal comfort extubation. Almost all patients with dyspnea documented by staff had orders and received opioids; however, few orders described treatment specifically for dyspnea. Patients with palliative care consultations more often received opioids ( P = .0007), and opioid orders more often specified treatment of dyspnea ( P = .013).

Conclusion: These findings support that previous work noting many patients experience dyspnea at end of life. Despite national guidelines, health care providers may still be underrecognizing and likely not optimally treating dyspnea at the end of life in the hospital. Collaboration with palliative medicine providers may improve assessments and treatments for quality end-of-life care for hospitalized patients.

Keywords: breathlessness; dyspnea; end-of-life care; hospital care; opioids; palliative care consultation; symptom prevalence.