I was reading an article recently that discussed the incidence of invasive and potentially harmful hospital treatments during a person’s last six months of life.
The article was an Australian review that looked at patients over 60 years of age and included an analysis of 38 studies, including data from 1.2million patients from 10 developed countries including Australia.
The ‘treatments’ or interventions continued into the last two weeks of a person’s life and included admissions to intensive care units, chemotherapy, resuscitation and intensive cardiac monitoring.
Let’s just recap that.
The last two weeks of a person’s life.
Intensive care unit admissions.
Chemotherapy.
Resuscitation.
The authors highlighted these ‘treatments’ as potentially preventing patients from having a comfortable death and prolonging suffering.
Ummm. Yes.
I’d like to tell you about a situation I became involved in at work.
It was one of the most emotionally rewarding situations I have had the privilege to be part of in my entire career.
I was contacted by one of the physicians on one of the wards in the hospital.
He asked me to give an opinion and some advice to his team and to the family of an elderly lady who had advanced dementia.
Whilst the multidisciplinary team was very attentive and keen to intervene in the care of this lady, the physician wasn’t sure if such interventions were appropriate in this instance.
These interventions included a speech pathologist undertaking a swallow test (to see if the lady could swallow without inhaling fluids or food) and a physiotherapist encouraging mobilisation (let’s get you up and about).
The lady ‘failed’ her swallow test and the recommendation from the speech pathologist to the doctors was to insert a naso gastric tube.
Can you see where this might be going?
I reviewed the lady.
She was approaching end of life.
I met with the son and daughter of the lady (the lady was so fatigued and barely able to speak and was happy for her son and daughter to speak on her behalf).
We discussed dementia as having a life limiting trajectory and that the signs their Mum was exhibiting reflected her approaching death.
We talked a lot about what this lady would like and not like in regards to her final days or weeks.
The son and daughter wanted to take their mother home to die.
I relayed this back to the physician.
He was fully supportive of this decision and recommended to the other clinicians involved that ‘active treatment’ would cease for this lady.
We made a plan for palliative care in her home and in collaboration with her package provider, we rearranged her Home Care Package to better meet her needs at this stage.
The beautiful outcome to this story was that the lady did die at home, 2 weeks later, surrounded by her family who were able to provide tender and loving care during those final days.
She died a peaceful, dignified death.
Her family drew strength from knowing that they were able to facilitate the kind of death their mother wanted.
But it could have been very different.
As a registered nurse working in a hospital, I accept that clinicians want to treat people, to make them better. That’s why people come to hospital isn’t it?…to get better.
But as end of life approaches I think there is another kind of conversation we should be having, as consumers and as clinicians.
The conversation regarding treating vs supporting, about acknowledging and accepting that death is inevitable and in doing so, supporting our loved ones and their families to understand, prepare and accept this transition.
And by doing so, giving our ageing loved one the right kind of farewell.
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