BACKGROUND: Nurses are at the forefront of providing end-of-life care to patients and families. Their knowledge, training and experience affect the quality of care.

Recently, Georgetown University Hospital completed a study to assess nurse's perceptions of the quality of end-of-life care provided at the hospital before and after participation in an End-of-Life Nurse Consortium Course. Another goal was to determine the effectiveness of the training.

RESULTS: About 52 percent of nurses in the study said they never received any end-of-life care training, yet 43 percent reported they had been involved in one to three end-of-life situations within the previous six months. The first survey showed the need for an educational intervention.

Over 100 nurses attended the course, and while survey results are still pending, there have been some changes. All newly-hired nurses at the hospital now receive the training, and all inpatient oncology and hematology nurses are required to take the end-of-life training course.

The study found nurses that receive end-of-life education and training can positively impact the lives of patients and families facing difficult times.

COST OF CARE: Patients with advanced cancer who discuss end-of-life care with their physicians appear to have lower health care costs in the final week of life than those who do not, according to a report in the Archives of Internal Medicine.

In the final week of life, patients who reported having end-of-life discussions with their doctors had average health care costs of $1,876 compared with $2,917 for patients who did not. Formal and informal caregivers who were interviewed after the patients' deaths reported that those with higher costs also had a worse quality of death in their final week.

FEAR OF ABANDONMENT: Another study shows patients who are dying and their families report that feelings of abandonment by their physicians at the end-of-life have two components: a loss of continuity of care before death and a lack of closure near death or afterward.

"Early on, patients and family caregivers fear that their physician, whose expertise and caring they have come to depend on, will become unavailable," the authors write.

Most physicians are not consciously aware of having abandoned their patients. Instead, they report lack of closure or a feeling of unfinished business.

The report could help physicians structure care to maintain the professional value of non-abandonment, including use of non-hospice palliative care or closure-promoting communication strategies involving nurses and other members of the health care team. As end-of-life approaches, physicians should offer assurances that they'll still be available and should maintain contact with the patient and caregiver, according to Anthony Back, M.D., of the Seattle Cancer Care Alliance, and colleagues.

For More Information, Contact:
Georgetown MD Physician Referral Line
(202) 342-2400
http://www.georgetownuniversityhospital.org/