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Spreading best practices for end-of-life care

At life's end, most people suffer physically, and also have significant emotional, spiritual, and social distress. This suffering can be made worse when aggressive, futile, and even harmful treatments are continued by physicians. Although palliative care treatment plans have the potential to improve the quality of end-of-life care and reduce hospital costs, such care is not routinely available in inpatient settings in which dedicated hospice units are not available.

Most people who do not have palliative care treatment plans are likely to die in hospitals and nursing homes. Researchers led by Drs. Kathryn Burgio and Amos Bailey of the Birmingham, Ala., VA Medical Center created the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial to test an intervention that could improve the quality of end-of-life care at VA medical centers.

The four-month intervention, tested at six VA medical centers, trained hospital staff to identify actively dying patients and to implement a set of best practices traditionally used in home-based hospice care. Some of the best practices the research team encouraged staff to implement were allowing patients access to their favorite food and drinks, minimizing invasive procedures, and encouraging family members to visit their loved ones for longer periods of time.

Over the course of six years, the team found that the intervention improved the last days of Veterans with respect to a number of care variables, including increasing the use of medication for pain or confusion, advance directives, and nasogastric tubes. The rates were the same for do-not-resuscitate orders, intravenous tubes, and restraints. The research team concluded that the intervention they developed has the potential to be widely distributed throughout VA, and to improve the quality of end-of-life care in VA medical centers and other hospital settings. (Journal of General Internal Medicine, Jan. 22, 2014)

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