About the project
Nearly half of all deaths in Norway occur in nursing homes. What is the doctor’s role in patient care at the end-of-life in nursing homes? Our project focuses three aspects:
- Drug prescribing near the end of life
- Evidence base for palliative drug treatment
- Challenges experienced by doctors working with dying nursing home patients
A cohort study among deceased nursing home patients showed that palliative medication was prescribed to 74% of patients on the day of death; especially for cancer patients and patients with long stays. Most drug changes occurred on the day of death.
Evidence-based drug treatment
A systematic review of the effectiveness (symptom control) and safety (side effects and survival) of palliative drug treatment of dying adult patients identified 5940 unique titles, from which 12 studies were included. Five studies assessed anticholinergics for death rattle, providing no evidence that scopolamine hydrobromide or atropine were superior to placebo. Five studies examined drugs for dyspnea, anxiety, or terminal restlessness, providing some evidence supporting the use of morphine and midazolam. Two studies examined opioids for pain, providing some support for morphine, diamorphine and fentanyl. Eight studies included safety outcomes, revealing no important differences in adverse effects between the interventions, and no evidence for midazolam shortening survival.
Focus group interviews exploring nursing home doctors' experiences with dying patients found that existential vulnerability, the vulnerability of being reminded of one’s mortality, is experienced as a burden of powerlessness and guilt in difficult treatment compromises and in the need for protective disengagement, but also as a resource in communication and professional coping.
Kristian Jansen defended his Ph.D. thesis «End of life care in nursing homes - Palliative drug prescribing and doctors’ existential vulnerability” at the University of Bergen 03.11.17. Link to BORA
Project period: 01.05.12 - 31.12.17
Funding: General Practice Research Fund