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Arch Intern Med. 2008 Apr 28;168(8):867-75. doi: 10.1001/archinte.168.8.867.

Circumstances of death in hospitalized patients and nurses' perceptions: French multicenter Mort-a-l'Hôpital survey.

Collaborators (483)

Dupont M, Kfoury M, Jarry P, Engelhorn M, Laroche B, Bayol B, Bompart F, Blanc G, Bulcourt M, Dupont H, Levasseur A, Theron A, Thiery P, Alleman S, Chalopin J, Coster C, Foin F, Fouchier M, Hily C, Laignel L, Plessis V, Bartoletti I, Deletraz P, Lenoir L, Rendu M, Salaun C, Merbai LT, Bertrand-Pellicer S, Bertrand-Pellicier J, Feraud M, Blin M, Champeau S, Coroier N, Royer D, Brajon Y, Courant M, Royer F, Rousset S, Bertrand D, Duteil M, Poinin-Aubaye C, Senecal M, Barreillon C, Boyaux I, Collin A, Parthiot V, Vidal N, Antoine R, Beck G, Bouverot F, Sabas S, Schneider JB, Gloriod A, Lemaire F, Riffard F, Bus D, Fortain OD, Dubois S, Guevellou M, Baudin A, Chaillou M, Chereau C, Metaireau F, Judith F, Lessieur K, Moureaud M, Mignot J, Perrin A, Vassalo H, Le Corre JL, Gaillard S, Orsini MJ, Bonnet MF, Dollard F, Maurice C, Paderi M, Elouard B, Cledes J, Legall M, Akkari F, Vaultier S, Eymard G, Lafaquiere B, Sauviat J, Bretonnet J, Faure B, Halley C, Jallet R, Cornu M, Chandelier C, Guillon G, Le Bilhan MH, Pellen S, Gandon JP, Recordon AM, Bondil P, Guegan V, Ferry R, Buton J, Darde C, Grabot C, Sandrine P, Trouillet V, Mongereau A, Rineau S, Sechet H, Mustier F, Peyraud N, Policard F, Saint Leger C, Panchevre I, Richter P, Roddier JP, Lopitaux R, Bicocchi C, Heintz F, Legrand J, Soulie M, Taillandier C, Tapia M, Arnoux S, Brun M, Hug F, Kowolik M, Maranzana A, Schelcher M, Schoenenberger M, Camalet V, Grondin C, Lable AM, Lenfant S, Liebert C, Benhamou-Jantelet G, Saliou C, Alessandrin L, Carpentier M, Dourte M, Dugrand M, Durruty A, Labarthe E, Sanguingt F, Senjean P, Coatmeur R, Guillaume M, Sautereau C, Jacquemin G, Sciluna E, Bricourt M, Perez B, De Lamartiere J, Dubouis S, Ledant C, Bourdon MP, Chambrin D, Cocheteux C, Deronne P, Vaillant S, Willems V, Guistel E, Morel N, Coathalem P, Pelissier C, Verdier R, Garcia C, Bordeau S, Chabrand D, Kieffer C, Wiegelt V, Bernard J, Noel J, Garnier MT, Maurand B, Steffann B, Colombat L, Engelstein A, Masson G, Reyt J, Roy E, Malek S, Couasnon I, Letailleur C, Labrouche S, Plagnol P, Dume F, Dupont L, Liez C, Barreteau M, Baudouin P, Brechet C, Coic C, Maquigneau N, Rabahand F, Villeneuve JM, Goichon A, Belaud M, Costec L, Gabez F, Philibert M, Biressi M, Branchard C, Doyen M, Escure F, Vincent C, Descours J, Lussiez F, Ceccaldi P, Macaud C, Bourgoin M, Bachy C, De Conninck C, Morel C, Pezim M, Grayeau C, Caron O, Roos Y, Thely D, Durand C, Durand E, Houdard N, Marneix F, Marot F, Holland B, Saint Wril N, D'Anjou MJ, Michel E, Chipaux M, Guedon C, Lucas F, Ostermann S, Begnic C, Abadie M, Boutelier S, Girard F, Lamarque R, Macias M, Mansaut JP, Perez L, Pernin S, Stoltz E, Welfringer P, Zanon P, Lepers P, Cilia M, Fournier C, Saillant M, Urbain J, Cartalat P, Frene M, Medalin I, Bosq P, Dobbeistein A, Jacque V, Costa J, Garcin I, Pellet J, Tetard C, Berteau N, Deneubourg A, Stephane P, Tisserand C, Vermeersch M, Geslin C, Dupre F, Lemaire F, Da Silva V, Berthier A, Thomas B, Gendre P, Bourquin P, Houze C, Houze M, Morel N, Rodier A, Dufour M, Grand J, Neuville B, Tarriottes M, Gregy M, Hasley M, Lutgen F, Chausset F, Baillet P, Mokhtari S, Gressier T, Rouby J, Lezin N, Geminard J, Derrien AM, Gireault M, Maillet-Vioud M, Mel B, Quemener F, Troadec C, Bruder C, Nass B, Pflugfelder V, Dawint N, Fauvel C, Laumesfeld J, Taillandier P, Caillaud R, Clement R, Leconte P, Mallet A, Demier C, Meinier F, Borelci F, Bourgeon J, Caroli-Bosc P, Castera V, Herrout E, Ladame-Hoff R, Mondain V, Raffermi C, Vigue MP, Virello H, Patatut E, Bertet M, Cauderlier J, Desmarais S, Quatrehomme S, Skarniak H, Dachicourt S, Desclaux C, Larroux D, Prat C, Goncalves M, Corbel N, Saltel C, Belorgey S, Derennes N, Kohler J, Partouche G, Roussel M, Veron C, Abitbol G, Jean M, Leconte F, Nadaud MJ, Picart-Jacq JY, Graff JP, Tissier A, Vezirian M, Bosc A, Thibaud S, Vezzoci M, Bruguiere-Fontenille F, Denis D, Sopta F, Thieffry E, Vinot C, Brebant A, Sanchez S, Bendahan B, Chardayre F, Charlot M, De Bernardy M, Hoarau G, Masseau N, Mione M, Batllo C, Bourlier E, Herpin S, Pezzetti F, Thomas N, Vignaud N, Maga B, Duverger M, Grador M, Marie M, Diard S, Jaubert M, Taboulet J, Vincent M, Costa J, Dupuy S, Leconte M, Marteil D, Clavio C, Lambion N, Geneau F, Koninck P, Negre C, Conbarnous D, Pocquet B, Le Mercier B, Carpin H, Do JP, Moustache J, Baudry M, Bernardet N, Debarre ML, Feston O, Lassagne-Bertrand N, Luneau E, Milon C, Paitre P, Troubat I, Archambault F, Puente M, Vedis A, Monnier D, Perrin V, Dubost L, Guilleux C, Gouriten M, Alain M, Rohn JP, Legrand C, Kazes I, Dufour M, Morin P, Nouvion MP, Letissier B, Gillet MN, Grosbois P, Loisel B, Husson P, Vallaeus L, Marteel C, Maryse S, Beaufils C, Duclos L, Le Brun Woinet M, Rale J, Toupin N, Bejot R, Brun D, Pichon-Galland M, Stierlam J, Alcaraz M, Vives L, Palak M, Vieau F, Clavier A, Morin B, Boussouak B, Chevet P, Moser I, Mugnier E, Renaudin S, Rossignol A, Chan J, Cayla C, Ferry C, Houde G, Mulpas S, Loirat P, Vidal MF, Decamps J, Morgante A, Forner R, Delory M, Forget T, Palanque C, Atallah F, Guillaume B, Plaza M, Boileau Y, Bouffart I, Lanson M, Meunier A, Pourrain M, Serna M, Simon M, Godin V, Rudant F, Lafrogne M, Raclot I, Roy E, Vantini M, Cobillon M, Gierens B, Bitsindou M, Roche AM, Gourdet J, Peillon D, Dubouch C, Lecaudey E, Prades M, Boblioue MC, Anne Halbin, Catherine Izylowski.

Abstract

BACKGROUND:

In developed countries at present, death mostly occurs in hospitals, but the circumstances and factors associated with the quality of organization and care surrounding death are not well described.

METHODS:

We designed a large multicenter cross-sectional study to analyze the setting and clinical course of each patient on the day of death. We included 2750 clinical departments of 294 hospitals. Of these, 1033 departments (37.6%) of 200 hospitals (68.0%) contributed to the Mort-a-l'Hôpital survey. Data were collected prospectively by the bedside nurse of each patient within 10 days of the occurrence of death. Main outcome measures included circumstances of death in hospitalized patients; secondary outcomes, nurses' perceptions of quality of end-of-life care.

RESULTS:

Of the 1033 participating departments, 420 recorded no deaths during the study period and 613 declared at least 1 death. In the 3793 patients who died and were included for assessment, only 925 (24.4%) had loved ones present at the time of death; 70.1% had respiratory distress during the period before death; and only 12.0% were in pain. Written protocols for end-of-life care were available in 12.2% of participating departments. Only 35.1% of nurses judged the quality of dying and death acceptable for themselves. Principal factors significantly associated with this perception were availability of a written protocol for end-of-life care, anticipation of death, informing the family, surrogate designation, adequate control of pain, presence of family or friends at the time of death, and staff meeting with the family after the death.

CONCLUSIONS:

This large prospective study identifies nonoptimal circumstances of death for hospitalized patients and a number of suggestions for improvement. A combination of factors reflected in the nurses' satisfaction may improve the quality of end-of-life care.

PMID:
18443263
DOI:
10.1001/archinte.168.8.867
[Indexed for MEDLINE]

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