Imminence of death of hospital inpatients
As the population ages and the number of deaths increases, the need for palliative care at the end of life is growing. How can clinicians and services identify those who might benefit from palliative care?
the study in Scotland
In March 2014 Professor David Clark and his team published a paper showing the likelihood of death within 12 months among a cohort of all hospital inpatients in Scotland on a fixed ‘census’ date.
It was the first time such a study had been conducted anywhere in the world. The study has been a call to action for hospitals to give greater priority to identifying inpatients who might benefit from palliative care.
The study established the number of hospital inpatients in an entire country who on a given day are within the last year of life. This study had no external funding but relied on complex record linkage analysis provided by NHS Scotland.
Published in Palliative Medicine, and quickly attaining the journal’s highest-ever Altmetrics score, Clark et al showed that among 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010, 3,098 (28.8%) patients died during the one-year follow-up period.
The likelihood of dying rose steeply with age and was three times higher at one year for patients aged 85+, compared to those under 60. Perhaps most striking of all was the finding that in Scottish hospitals on any given day, almost one in ten patients (9.3%) will die before they leave.
The study attracted the attention of Scottish government officials and has been referenced in key documents relating to seven-day care. Professor Clark was invited to take the role of Consulting Editor during the production of Scotland’s Strategic Framework for Action on Palliative and End of Life Care.
A follow-up study confirmed the findings, which suggest that the culture and organization of hospitals need to become more attuned to the high proportion of inpatients in imminent need of end of life care.
The project has created significant international interest and is being replicated in a three-country comparison study including Denmark and New Zealand, using a new census date and methodology for all three countries.
The work complements our wider research programme Global Interventions at the End of Life, funded by a Wellcome Trust Senior Investigator Award to Professor Clark, which seeks to understand how end of life interventions around the world are developed, implemented and assessed.
media responses to the study
With its clear implications for practice and policy, the study attracted a huge amount of media interest at the time of publication:
- coverage in 8 national newspapers
- 40+ radio clips and 15+ regional TV clips on the BBC UK network
- BBC breakfast and News 24 coverage
- features on Radio 4 Today Programme, BBC Radio 2 and BBC Five Live, Scottish Radio (5 clips), Scottish Television (BBC Reporting Scotland, Scotland Tonight, STV News), and BBC online
- One-third of hospital patients 'die within 12 months', Martin Williams, The Herald, 19/03/14
- Death is 'core business' of Scottish hospitals, university study finds, Eleanor Bradford, BBC Scotland, 19/03/2014
The study continues to inspire reports including:
- Hospitals begin to think more about palliative care, Stephen Naysmith, The Herald 16/11/2015
- Grasping the nettle – what action can we take to improve palliative and end of life care in Scotland? Mark Hazelwood, ehospice, 16/12/15
- Ensuring everyone who needs palliative care gets it in Scotland by 2021, Richard Meade, Marie Curie Scotland blog, 17/12/15
- Care at the end of life: New framework to improve services for all, Scottish Government press release, 18/12/15
- Good Morning Scotland, Professor David Clark interviewed on BBC Radio Scotland, 0715 18/12/15 (available until 18/01/16)
- ‘Joined-up’ plan for palliative care across all health departments, Eleanor Bradford, BBC Scotland News, 18/12/15
- Palliative care given £3.5m boost in new 5-year NHS plan, Lizzy Buchan, The Scotsman, 18/12/15
- Everyone to have palliative care access, pledges Scottish Government, STV, 18/12/15
- Patients to get greater say in end-of-life care, Tom Freeman, The National, 18/12/15
- Scottish government commits to ensuring everyone in Scotland gets good quality palliative and end of life care, Tom Moran, ehospice UK, 18/12/15
- Five-year plan aims to widen access to palliative care for all, Press Association, 18/12/15
- Launch of the Strategic Framework for Action on Palliative and End of Life Care, Scottish Care, 18/12/15
- Hospice UK responds to the Scottish Government’s Strategic Framework for Action – Palliative and End of Life Care, Hospice UK, 18/12/15
- Charities praise £3.5m palliative care measures, Janice Burns, The National, 19/12/15
- New palliative care framework unveiled, The Times, 19/12/15
- Putting palliative care at the heart of health service, Lizzy Buchan, Edinburgh Evening News, 21/12/15
- Palliative care guidance required, Pamela Mackenzie, Assistant Director for Scottish services, Sue Ryder, Herald Scotland Opinion 21/12/2015
- Forget ‘same old’ for end of life care, Lesley Riddoch, The Scotsman, 10/01/2016
on our blog
The study of the imminence of death of Scottish hospital inpatients has created significant international interest and is being replicated in a three-country comparison study including Denmark and New Zealand, using a new census date and methodology for all three countries.
Clark, D. , Schofield, L., Graham, F. M., Gott, M. and Jarlbaek, L. (2016) Likelihood of death within one year among a national cohort of hospital inpatients in Scotland. Journal of Pain and Symptom Management, 52(2), e2-e4. (doi: 10.1016/j.jpainsymman.2016.05.007) (PMID:27262261)
Clark, D. , Schofield, L., Graham, F., Jarlbaek, L., Gott, M. and Isles, C. (2015) Hospital care in the last year of life. British Medical Journal, 2015(351), h4266. (doi: 10.1136/bmj.h4266) (PMID:26253242)
Clark, D. , Armstrong, M., Allan, A., Graham, F., Carnon, A. and Isles, C. (2014) Imminence of death among a national cohort of hospital inpatients: Prevalent cohort study. Palliative Medicine, 28(6), pp. 474-479. (doi: 10.1177/0269216314526443) (PMID:24637342) (PMCID:PMC4845030)