[End-of-life care pathways of patients followed in palliative care in Strasbourg: A retrospective study]

Abstract

Objectives: The goal of palliative care is to relieve suffering and provide the best possible quality of life for patients and their families. We looked for individual factors related to a poor-quality end-of-life pathway in patients followed in palliative care.

Methods: We included all the patients followed in palliative care in Strasbourg deceased from October to December of 2020. We retrospectively collected data about these patients, their first contact with palliative care, their care pathway, and their death. Multivariate analysis was undertaken.

Results: In total, 116 patients were included. Seventy-nine of them had cancer. At the end of life, people living in an institution were less likely to be admitted to the emergency department (OR=0.06), as were non-communicative patients (OR=0.08). Patients expressing a wish to die at home were less likely to be admitted to and die in an intensive care unit (OR=0.1). Isolated patients and non-communicative patients appeared protected from aggressive treatment (chemotherapy/immunotherapy, dialysis, orotracheal intubation, cardiopulmonary resuscitation) during the last month of life (OR=0.1, OR=0.05).

Discussion: Our study suggests a profile of patients less exposed to invasive or unreasonable care at the end of life. It leads us to pay particular attention to young subjects, with family, living at home. In our population followed in palliative care, exposure to aggressive care at the end of life appeared to be very low compared to that observed in similar studies with other populations.

Keywords: Agressivité des soins; Care aggressiveness; End-of-life; Fin de vie; Lieu de décès; Palliative care; Place of death; Soins palliatifs.