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Pharmacological treatment and assessment of symptoms at the end of life in European nursing homes

Author: Marc Tanghe




Date: 05-07-2022

Prof. dr. Ruth Piers (Promotor Ghent University), Prof. dr. Lieve Van den Block (Promotor, Vrije Universiteit Brussel)
Prof. dr. Nele Van Den Noortgate (Copromotor Ghent University), Prof. dr. Luc Deliens (Copromotor, Vrije Universiteit Brussel)

Summary of the dissertation

Taken the demographic evolution into account, nursing homes will continue to be major providers of palliative care for the frail aged in Europe. For the nursing home residents with multiple, complex comorbidities, symptom management remains an essential palliative care need. Symptom management in end-of life in nursing homes in six European countries was the subject of this dissertation. Symptom management is an ongoing cycle of symptom assessment and symptom treatment.

With regard to the pharmacological treatment of symptoms, we compared the prescription of opioids, antipsychotics, and hypnotics in the last three days of life of nursing home residents (chapter 2). We found large differences in the prescription of opioids, antipsychotics, and hypnotics between countries. The resident’s country appeared to be the predominant factor associated with opioid, antipsychotic and hypnotic use. Dying from cancer tripled the odds for receiving opioids and doubled the odds for receiving hypnotics in the last days of life.

For opioids, more particularly, we explored possible underuse and searched for associated factors (chapter 3). Opioid underuse differed significantly between countries. Opioid underuse was more prevalent in residents with dyspnoea then in residents with pain and residents suffering from both symptoms. Odds of opioid underuse lowered to a third when pain was assessed.

With regard to the assessment of symptoms, we described the residents’ symptom burden at the end of life and explored differences in the perception of symptoms between professional staff and family carers (chapter 4).

On group level, mean staff scores significantly reflected better comfort than those of family carers for the total symptom burden and for the physical distress and dying symptoms. No significant differences were found for emotional distress and well-being. We found poor agreement in individual ratings, concomitantly with little systematic difference.

Lastly, we developed and validated the SATISFIE tool, an instrument for regular, multiple-symptom assessment in institutionalised elderly (chapter 5). SATISFIE is a tool for self-assessment of then frequently prevalent and potentially burdensome symptoms and offers the possibility to assess three additional symptoms, mentioned by the patient. The SATISFIE- tool was found to be feasible for regular multi-symptom assessment in clinical practice.