TY - JOUR
T1 - Frequency and factors associated with unexpected death in an acute palliative care unit
T2 - Expect the unexpected
AU - Bruera, Sebastian
AU - Chisholm, Gary
AU - Dos Santos, Renata
AU - Bruera, Eduardo
AU - Hui, David
N1 - Publisher Copyright:
© 2015 American Academy of Hospice and Palliative Medicine.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Context Few studies have examined the frequency of unexpected death and its associated factors in a palliative care setting. Objectives To determine the frequency of unexpected death in two acute palliative care units (APCUs); to compare the frequency of signs of impending death between expected and unexpected deaths; and to determine the predictors associated with unexpected death. Methods In this prospective, longitudinal, observational study, consecutive patients admitted to two APCUs were enrolled and physical signs of impending death were documented twice daily until discharge or death. Physicians were asked to complete a survey within 24 hours of APCU death. The death was considered unexpected if the physician answered "yes" to the question "Were you surprised by the timing of the death?" Results In total, 193 of 203 after-death assessments (95%) were collected for analysis. Nineteen of 193 patients died unexpectedly (10%). Signs of impending death, including non-reactive pupils, inability to close eyelids, decreased response to verbal stimuli, drooping of nasolabial folds, peripheral cyanosis, pulselessness of the radial artery, and respiration with mandibular movement, were documented more frequently in expected deaths than unexpected deaths (P < 0.05). Longer disease duration was associated with unexpected death (33 months vs. 12 months, P = 0.009). Conclusion Unexpected death occurred in an unexpectedly high proportion of patients in the APCU setting and was associated with fewer signs of impending death. Our findings highlight the need for palliative care teams to be prepared for the unexpected.
AB - Context Few studies have examined the frequency of unexpected death and its associated factors in a palliative care setting. Objectives To determine the frequency of unexpected death in two acute palliative care units (APCUs); to compare the frequency of signs of impending death between expected and unexpected deaths; and to determine the predictors associated with unexpected death. Methods In this prospective, longitudinal, observational study, consecutive patients admitted to two APCUs were enrolled and physical signs of impending death were documented twice daily until discharge or death. Physicians were asked to complete a survey within 24 hours of APCU death. The death was considered unexpected if the physician answered "yes" to the question "Were you surprised by the timing of the death?" Results In total, 193 of 203 after-death assessments (95%) were collected for analysis. Nineteen of 193 patients died unexpectedly (10%). Signs of impending death, including non-reactive pupils, inability to close eyelids, decreased response to verbal stimuli, drooping of nasolabial folds, peripheral cyanosis, pulselessness of the radial artery, and respiration with mandibular movement, were documented more frequently in expected deaths than unexpected deaths (P < 0.05). Longer disease duration was associated with unexpected death (33 months vs. 12 months, P = 0.009). Conclusion Unexpected death occurred in an unexpectedly high proportion of patients in the APCU setting and was associated with fewer signs of impending death. Our findings highlight the need for palliative care teams to be prepared for the unexpected.
KW - Cohort studies
KW - death
KW - epidemiology
KW - neoplasms
KW - palliative care
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=84929703938&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84929703938&partnerID=8YFLogxK
U2 - 10.1016/j.jpainsymman.2014.10.011
DO - 10.1016/j.jpainsymman.2014.10.011
M3 - Article
C2 - 25499421
AN - SCOPUS:84929703938
SN - 0885-3924
VL - 49
SP - 822
EP - 827
JO - Journal of pain and symptom management
JF - Journal of pain and symptom management
IS - 5
ER -