Problems associated with care at the end of life in acute hospitals

Many more people die in acute hospitals than ever before. An integrative literature review was undertaken to explore end-of-life care (EoLC) delivered in non-palliative care settings. It showed that providing EoLC in acute hospitals is difficult, given the emphasis on life extension and cure. EoLC pathways can assist with the planning and delivery of care. According to an international report, the UK and Australia lead the world in quality care at the end of life. However, even in these countries, acute hospital culture has the potential to have a negative effect on care of dying people. There is a false assumption that clinicians are educationally, culturally and emotionally prepared to recognise dying and respond appropriately. This article reviews the delivery of EoLC in acute hospitals. It identifies workplace cultural difficulties and care-delivery models that impact on providing quality EoLC. Programmes and initiatives that seek to address cultural, health service and educational issues are identified and discussed. The knowledge deficit of health professionals, in particular nurses, with regard to providing quality EoLC is also examined.