Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

摘要

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04 vs. 36.3 p = 0.367), methadone (9.60 vs. 4.39 p = 0.247), midazolam (43.05 vs. 47.80 p = 0.73), blood transfusions (31.13 vs. 24.63 p = 0.828), enteral feeding (56.62 vs. 38.54 p = 0.59) and antibiotic therapy (50.73 vs. 50.73 p = 0.435). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.