Does the hospitalization of patients with acute problems at the end of life add to their suffering?
Suffering, which is different from pain, occurs when a person experiences a threat to their wholeness as a person. It may occur because of myriad experiences, including medical treatments. The experience of acute hospitalization of patients near death can worsen their suffering. Avoiding futile measures, treating them with respect and dignity, and attending to the unpleasant milieu of the hospital environment may decrease this unnecessary suffering.(LOE = 4)
Overuse alert: This POEM aligns with Choosing Wisely Canada's serious illness conversation initiative.
Plan de l'etude:
Self-funded or unfunded
Inpatient (ward only)
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.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine