Acute hospitalization of near-death patients can result in unnecessary suffering

Référence

Green L, Capstick A, Oyebode J. Iatrogenic suffering at the end of life: an ethnographic study. Palliat Med 2023 Apr 23:2692163231170656. doi: 10.1177/02692163231170656. Online ahead of print.

Sommaire

This study was conducted in a single ward of a medium-sized hospital. One investigator is an experienced palliative care nurse who specifically studied the care of 11 patients thought to be in the last few weeks of their life who were admitted for an acute problem. That investigator, who collected all the data for this ethnographic study, took extensive field notes on the care of these patients, as well as on discussions held during nursing shift changes and informal interviews with patients, staff, and visitors. The authors used inductive coding to develop themes that identified ways in which acute care increased patient suffering. Iatrogenic factors that increased suffering included the use of interventions that were subsequently deemed to have been unnecessary or burdensome (eg, initiating tube feeding in an unresponsive patient with heart and renal failure who died within 4 days of the tube placement). Interactional iatrogenesis occurred when patient suffering was worsened through uncompassionate, objectifying, or patronizing interactions, such as addressing an adult patient as if he or she were a child. Environmental iatrogenesis increased suffering when the physical environment, and how it was experienced, appeared to exacerbate suffering (eg, undesirable noises or smells that bothered patients without seemingly being noticed by staff). The data were later shared with staff, and while they found the feedback challenging to hear, they found the experience instructive.