Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
BMC Palliat Care. 2009 Dec 30;8:20. doi: 10.1186/1472-684X-8-20.
The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals.
A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level.
The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals.
Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care providers about these policies is not always provided, and quality assessment tools are used in less than half of the hospitals.
在比利时佛兰德斯，安乐死于 2002 年合法化，因此对机构临终政策的流行程度和实施情况进行了全面研究。在医院制定临终政策是提高临终医疗决策质量的第一步。通过质量评估、沟通以及对医疗保健提供者的培训和教育来实施政策，对于改善实际临终实践同样重要。本研究旨在报告佛兰德斯急性医院实施临终政策的情况。
对佛兰德斯（比利时）所有急性医院（67 个主校区）进行了横断面邮件调查。问卷询问了医院的特点、五种临终决策类型的政策流行情况：安乐死、缓和性镇静、减轻可能缩短生命的症状、不复苏决定以及停止或撤回治疗，这些政策的内部和外部沟通，临终关怀方面的培训和教育，以及患者和家庭层面的临终关怀质量评估。
回复率为 55%。结果表明，2007 年，大多数类型的临终决策的书面政策在急性医院中广泛存在（安乐死：97%，不复苏决定：98%，缓和性镇静：79%）。虽然这些政策向医疗保健提供者的标准沟通率在 71%至 91%之间，但向患者和/或家属的沟通率要低得多（在 17%至 50%之间）。超过 60%的机构在不同方面对护理人员进行了临终关怀培训和教育。这些医院中有 25%至 61%对这些不同方面的患者和家庭层面的质量进行了评估。
大多数佛兰德斯急性医院都制定了临终实践政策。然而，对这些政策的沟通、培训和医疗保健提供者的教育并不总是提供，并且不到一半的医院使用质量评估工具。
