Identifying Dutch Hospitalized Patients with a Limited Life Expectancy and Palliative Care Team Involvement: A Flashmob Study

ABSTRACT

Background/aims: Many hospitalized patients have a life-limiting condition. It is not known how many patients this concerns and if these patients receive palliative care. This study aimed to investigate how many patients with a probable limited life expectancy were hospitalized and if a palliative care team (PCT) was involved or whether involvement was considered desirable. Methods: A flashmob study was conducted in Dutch hospitals on the 16th of April 2021 at all wards, except the pediatric and obstetric wards, emergency departments and day care departments. For all hospitalized patients, nurses and doctors independently answered the surprise question (SQ) “Would you be surprised if this patient died within the next 12 months?” as well as treatment limitations and palliative care team (PCT) involvement. Results: In 48 hospitals, surveys were completed for 8789 patients. Patients were admitted to surgical wards in 33% and to general medicine wards in 67%. The SQ was negatively answered in 35% by doctors and in 32% by nurses for the total population. Among patients admitted for a malignancy, non-malignant disease or COVID-19 doctors answered the SQ negatively in 49%, 32% and 33% respectively. Life expectancy was estimated to be less than three months in 7.3% for the total population. Treatment limitations were recorded in 39.5% of the total population. The PCT was involved in 2.2% and involvement was desirable in 2.1%, increasing to 15.1% and 12.9% when life expectancy was estimated as less than three months. Conclusions: In more than one-third of hospitalized patients, the SQ was answered negatively, suggesting a limited life expectancy and possible palliative care needs. PCT involvement was considered of added value by healthcare professionals in 4.3% of the whole population. Further studies should focus on exploration of palliative care needs of hospitalized patients and possible benefits of timely implementation of specialized palliative care.