Non-beneficial treatments in hospital at the end of life: A systematic review on extent of the problem
International Journal for Quality in Health Care, ISSN: 1464-3677, Vol: 28, Issue: 4, Page: 456-469
2016
- 277Citations
- 300Captures
- 12Mentions
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Metrics Details
- Citations277
- Citation Indexes262
- 262
- CrossRef91
- Academic Citation Index (ACI) - airiti2
- Policy Citations15
- Policy Citation15
- Captures300
- Readers300
- 290
- 10
- Mentions12
- News Mentions11
- News11
- Blog Mentions1
- Blog1
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Article Description
Purpose: To investigate the extent of objective 'non-beneficial treatments (NBTs)' (too much) anytime in the last 6 months of life in routine hospital care.Data sources: English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-April 2015).Study selection: All study types assessing objective dimensions of non-beneficial medical or surgical diagnostic, therapeutic or non-palliative procedures administered to older adults at the end of life (EOL).Data extraction: A 13-item quality score estimated independently by two authors.Results of data synthesis: Evidence from 38 studies indicates that on average 33-38% of patients near the EOL received NBTs. Mean prevalence of resuscitation attempts for advanced stage patients was 28% (range 11-90%). Mean death in intensive care unit (ICU) was 42% (range 11-90%); and mean death rate in a hospital ward was 44.5% (range 29-60%). Mean prevalence of active measures including dialysis, radiotherapy, transfusions and life support treatment to terminal patient was 7-77% (mean 30%). Non-beneficial administration of antibiotics, cardiovascular, digestive and endocrine treatments to dying patients occurred in 11-75% (mean 38%). Non-beneficial tests were performed on 33-50% of patients with do-not-resuscitate orders. From meta-analyses, the pooled prevalence of non-beneficial ICU admission was 10% (95% CI 0-33%); for chemotherapy in the last six weeks of life was 33% (95% CI 24-41%).Conclusion: This review has confirmed widespread use of NBTs at the EOL in acute hospitals. While a certain level of NBT is inevitable, its extent, variation and justification need further scrutiny.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84991786859&origin=inward; http://dx.doi.org/10.1093/intqhc/mzw060; http://www.ncbi.nlm.nih.gov/pubmed/27353273; https://academic.oup.com/intqhc/article/28/4/456/2594949; https://dx.doi.org/10.1093/intqhc/mzw060; https://academic.oup.com/intqhc/article-abstract/28/4/456/2594949?redirectedFrom=fulltext; https://research-repository.uwa.edu.au/en/publications/a2ef9ce6-37ae-43ed-9d70-52ed39ede41e; https://research-repository.uwa.edu.au/en/publications/non-beneficial-treatments-in-hospital-at-the-end-of-life-a-system; http://intqhc.oxfordjournals.org/lookup/doi/10.1093/intqhc/mzw060; https://academic.oup.com/intqhc/article-pdf/28/4/456/28035869/mzw060.pdf; https://research-repository.uwa.edu.au/en/publications/nonbeneficial-treatments-in-hospital-at-the-end-of-life-a-systematic-review-on-extent-of-the-problem(a2ef9ce6-37ae-43ed-9d70-52ed39ede41e).html; http://research-repository.uwa.edu.au/en/publications/nonbeneficial-treatments-in-hospital-at-the-end-of-life-a-systematic-review-on-extent-of-the-problem(a2ef9ce6-37ae-43ed-9d70-52ed39ede41e).html
Oxford University Press (OUP)
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