Variaties in de zorg in Nederlandse hospices

Background

Hospice care in The Netherlands is provided through three differing types of hospice, including hospices where care is primarily provided by volunteers (BTH), palliative units that operate as part of nursing homes (PUs) and independent hospices with specialist trained palliative care staff (HCHs). Clinical guidelines have been developed internationally to reduce variations in clinical practices and promote the quality of palliative care. This study aims to examine clinical practices through different hospice types and identify variations in care.

Methods

Retrospective cohort study utilising clinical documentation review, including patients who received inpatient palliative care at 51 different hospices and died in 2017 or 2018. Care provision for each patient for the management of pain, delirium and palliative sedation were analysed according to the Dutch national guidelines.

Results

112 patients were included who received treatment for pain, 53 for delirium, and 116 patients underwent palliative sedation therapy. Care was provided in accordance with guidelines for pain in 32%, 61% and 47% (p=0.047), delirium in 29%, 78% and 79% (p=0.002), and palliative sedation in 35%, 63% and 42% (p=0.067) of patients who received care in BTHs, HCHs and PUs respectively. When all clinical practices were considered, patient care was conducted according to the guidelines for 33% of patients in BTHs, 65% in HCHs, and 50% in PUs (p<0.001).

Conclusions

The data demonstrate that care practices are not standardised throughout Dutch hospices and exhibit variations between type of hospice. Employing clinical guidelines in daily practice may reduce these variations and promote quality care.

Conflict of interest and financial support: This project was funded through The Netherlands Organisation for Health Research and Development (ZonMW) – project number 844001406. ICMJE forms provided by the authors are available online along with the full text of this article.