PT  - JOURNAL ARTICLE
AU  - Daniel Kobewka
AU  - Paul Ronksley
AU  - Dan McIsaac
AU  - Sunita Mulpuru
AU  - Alan Forster
TI  - Prevalence of symptoms at the end of life in an acute care hospital: a retrospective cohort study
AID  - 10.9778/cmajo.20160123
DP  - 2017 Mar 09
TA  - CMAJ Open
PG  - E222--E228
VI  - 5
IP  - 1
4099  - http://www.cmajopen.ca/content/5/1/E222.short
4100  - http://www.cmajopen.ca/content/5/1/E222.full
AB  - Background: There is currently debate over the benefits and harms of physician-assisted death. One of the factors influencing this debate is concern about symptoms in the days before death. The objective of this study was to describe the frequency of symptoms before death and determine patient characteristics associated with these symptoms.Methods: We reviewed the medical record of every patient who died at a multisite academic teaching hospital over a 3-month period. We determined the number of episodes of pain, dyspnea, agitation and nausea during the final 48 hours of life and assessed the patient and encounter characteristics associated with 2 or more episodes of symptoms.Results: A total of 480 patients died during the study period. Of these patients, 29.2% (140/480) had 2 or more symptoms in the final 48 hours of life. Higher Elixhauser comorbidity scores (relative risk [RR] 1.35, 95% confidence interval [CI] 1.23-1.49), having a family doctor (RR 2.33, 95% CI 1.02-5.38), being admitted to the medical oncology service (RR 1.51, 95% CI 1.11-2.05) and having a documented order for no resuscitation written early during the stay in hospital (RR 1.38, 95% CI 1.01-1.89) were independently associated with symptoms. Admission to intensive care was associated with fewer symptoms (RR 0.39, CI 95% 0.19-0.80).Interpretation: Symptoms are common in the final 48 hours of life, particularly in patients with multimorbidity who want limitations on the aggressiveness of their care. An integrated palliative approach is needed for select at-risk patients.