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Multicenter Study
. 2019 Nov 4;9(11):e030955.
doi: 10.1136/bmjopen-2019-030955.

Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia

Hannah Elizabeth Carter  1 , Xing Ju Lee  2 , Cindy Gallois  3 , Sarah Winch  4 , Leonie Callaway  4   5 , Lindy Willmott  6 , Ben White  6 , Malcolm Parker  4 , Eliana Close  6 , Nicholas Graves  2   7
Affiliations
Multicenter Study

Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia

Hannah Elizabeth Carter et al. BMJ Open. .

Abstract

Objective: To quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life.

Design: Retrospective multicentre cohort study.

Setting: Three large, metropolitan tertiary hospitals in Australia.

Participants: 831 adult patients who died as inpatients following admission to the study hospitals over a 6-month period in 2012.

Main outcome measures: Odds ratios (ORs) of NBT derived from logistic regression models.

Results: Overall, 103 (12.4%) admissions involved NBTs. Admissions that involved conflict within a patient's family (OR 8.9, 95% CI 4.1 to 18.9) or conflict within the medical team (OR 6.5, 95% CI 2.4 to 17.8) had the strongest associations with NBTs in the all subsets regression model. A positive association was observed in older patients, with each 10-year increment in age increasing the likelihood of NBT by approximately 50% (OR 1.5, 95% CI 1.2 to 1.9). There was also a statistically significant hospital effect.

Conclusions: This paper presents the first statistical modelling results to assess the factors associated with NBT in hospital, beyond an intensive care setting. Our findings highlight potential areas for intervention to reduce the likelihood of NBTs.

Keywords: adult intensive and critical care; adult palliative care; clinical audit; health and safety; medical ethics; quality in health care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Factors associated with NBT in the final fitted all subset regression logistic model. Point estimates are represented by dots, and 95% CIs are shown as bars. Green bars are statistically significant at 0.05 significance level. ICU, intensive care unit; NBT, non-beneficial treatment; SPICT, Supportive & Palliative Care Indicators Tool.
See this image and copyright information in PMC

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