Discussing End-Of-Life issues in nursing homes: A nationwide study in France

Abstract

Background: Discussing End-Of-Life issues with nursing home residents and their relatives is needed to ensure Patient-Centred care near the end of life. Objectives: This study aimed to estimate the frequency of nursing home physicians discussing End-Of-Life issues with residents and their relatives and to investigate how discussing End-Of-Life issues was associated with care outcomes in the last month of life. Methods: Post-Mortem cohort study in a nationwide, representative sample of 78 nursing home facilities in France. Residents who died from Non-Sudden causes between 1 October 2013 and 31 May 2014 in these facilities were included (n=674). Results: End-Of-Life issues were discussed with at most 21.7% of the residents who died during the study period. In One-Third of the situations (32.8%), no discussion about End-Of-Life-Related topics ever occurred, either with the resident or with the relatives. Older people with severe dementia were less likely to have discussed more than three of the six End-Of-Life topics we investigated, compared with residents without dementia (OR=0.17, 95% CI=0.08-0.22). In the last month of life, discussing more than three End-Of-Life issues with the residents or their relatives was significantly associated with reduced odds of dying in a hospital facility (adjusted OR=0.51, 95% CI=0.33-0.79) and with a higher likelihood of withdrawing potentially futile Life-Prolonging treatments (adjusted OR=2.37, 95% CI=1.72-3.29). Conclusion: During the last months of life, discussions about End-Of-Life issues occurred with only a minority of nursing home decedents, although these discussions may improve End-Of-Life care outcomes.