Care of dying patients in hospital Palliative care teams have helped

EDITOR, - It is disappointing that Mina Mills and colleagues make no comment in their paper on the care of dying patients in hospital about changes that may have led to improvements in the past decade.1 Their study showed a lack of nursing care for dying patients, but whether this poor standard of care was applied to all patients admitted to hospitals in the study is not clear. For example, what was the standard of care for patients with stroke or other chronic disability? A similar study performed 10 years after the original would have been useful in showing any improvements or otherwise in practice. Nursing care may still be a problem, but perhaps this reflects general attitudes and staffing levels rather than a specific failure to address the needs of dying patients.

Several reasons exist for assuming that change may have occurred since 1983. In 1987 the Department of Health issued a circular directing distric health authorities to examine their provision of services for dying patients.2 It was in this year too that palliative medicine became a recognised medical specialty. A substantial increase in Macmillan nurses has occurred, from 260 in 1984 to 1200 in 1994 (personal communication, Cancer Relief Macmillan Fund). Parallel to these changes has been an increase in hospital palliative care or support teams, from 13 in 1983 to 216 in 1993.3

To conclude that “we need to identify and implement practical steps to facilitate high quality care of the dying” without a brief discussion of the role of hospital palliative care teams shows an ignorance of current practice. As well as organising education for nursing and medical colleagues these palliative care teams try to help patients identify symptoms that distress them and work with the patients and staff to resolve these whenever possible. A recent paper showed the effectiveness of hospital teams in establishing early contact with dying patients and linking them with palliative care resources in the community.4