End-of-Life Care in Private Hospitals

Objective: To develop an overview of end-of-life care (EOLC) for patients with cancer within the private hospital setting and identify the key factors influencing the care provided. Design: A cross-sectional multi-method design was used to compare two private hospitals in Melbourne, Australia to examine the provision of EOLC for patients with cancer. Retrospective chart audit, interviews (audiotaped), hospital data and policy document review were used to compare the two hospitals. Sample and Setting: Medical records of patients with a cancer diagnosis who had died in the preceding 12 months (N=67), and senior staff (N=9) from two private hospitals in Melbourne (Hospital A and Hospital B). Main outcome measures: Hospital data identified staffing profiles, education and support services. Medical records provided evidence of assessment of deterioration leading to death, symptom management, links with palliative care services, involvement of other staff, and psychosocial, spiritual and bereavement support. Policy documents were examined for references to palliative care and/or EOLC and staff interviews elicited their perspective of EOLC as currently delivered in each hospital. The Palliative Care Australia (PCA) Standards for the Provision of Palliative Care 'palliative approach' were used as a framework for presenting and discussing findings. Findings: While palliative care was not a designated specialty in either hospital, EOLC was influenced by the core specialities of each hospital. Elements of a 'palliative approach' to care were evident in both hospitals. Conclusions: The project has provided recognition of work not previously reported, about EOLC in private hospitals in Australia. Areas for improvement include support for staff in relation to education and development of appropriate end-of-life care policies; referral process to specialist palliative care; and spiritual and bereavement care for patients and their families. The study is timely, with recent proposed changes to private health insurance to incorporate the provision of palliative care services in all settings.