Changes in medical and nursing care after admission to palliative care units: A potential method for improving regional palliative care

Purpose: The purpose of the study was to evaluate changes in medical and nursing care for patients just after admission to a palliative care unit (PCU) from general wards in one city. Methods: Subjects were 260 consecutive patients admitted to a PCU. Data on changes in medical and nursing care occurring just after admission were collected prospectively using a structured data collection sheet about four areas: (1) medical treatment, (2) nursing care, (3) giving additional information about the patient's condition to the patient and/or the family, and (4) obtaining psychosocial information. Results: The mean number of total changes was 8.0±5.6 per patient. The most common changes in medical treatment were initiation or increase of opioids (18%), discontinuation or decrease in artificial hydration (16%), initiation of steroids (13%), initiation of antiemetics (9%), initiation of antibiotics (8%), and initiation of nonsteroidal antiinflammatory drugs (7%). The most common changes in nursing care were starting oral care (19%), permission to take a bath (11%), and change in the pattern of meals (8%). Information about the patient's condition was given most frequently to key family members (27%). Psychosocial information obtained most frequently was about the family's expectations regarding the PCU and insight into the patient's condition (53% and 41%, respectively). Conclusions: Changes in medical and nursing care were frequent, and the frequency of local healthcare providers' assessment of the changes may be insufficient. Providing general ward staff with data about changes in interventions occurring just after PCU admission might be effective for improving palliative care for terminal patients.