Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia
Objective To quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life.Design Retrospective multicentre cohort study.Setting Three large, metropolitan tertiary hospitals in Australia.Participants 831 adult patients who died as inpati...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2019-11-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e030955.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846149599909117952 |
|---|---|
| author | Nicholas Graves Hannah Elizabeth Carter Eliana Close Lindy Willmott Cindy Gallois Malcolm Parker Sarah Winch Ben White Xing Ju Lee Leonie Callaway |
| author_facet | Nicholas Graves Hannah Elizabeth Carter Eliana Close Lindy Willmott Cindy Gallois Malcolm Parker Sarah Winch Ben White Xing Ju Lee Leonie Callaway |
| author_sort | Nicholas Graves |
| collection | DOAJ |
| description | Objective To quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life.Design Retrospective multicentre cohort study.Setting Three large, metropolitan tertiary hospitals in Australia.Participants 831 adult patients who died as inpatients following admission to the study hospitals over a 6-month period in 2012.Main outcome measures Odds ratios (ORs) of NBT derived from logistic regression models.Results Overall, 103 (12.4%) admissions involved NBTs. Admissions that involved conflict within a patient’s family (OR 8.9, 95% CI 4.1 to 18.9) or conflict within the medical team (OR 6.5, 95% CI 2.4 to 17.8) had the strongest associations with NBTs in the all subsets regression model. A positive association was observed in older patients, with each 10-year increment in age increasing the likelihood of NBT by approximately 50% (OR 1.5, 95% CI 1.2 to 1.9). There was also a statistically significant hospital effect.Conclusions This paper presents the first statistical modelling results to assess the factors associated with NBT in hospital, beyond an intensive care setting. Our findings highlight potential areas for intervention to reduce the likelihood of NBTs. |
| format | Article |
| id | doaj-art-6de7e473c6c34ca5a913e795462dc3e0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-6de7e473c6c34ca5a913e795462dc3e02024-11-29T13:15:13ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-030955Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in AustraliaNicholas Graves0Hannah Elizabeth Carter1Eliana Close2Lindy Willmott3Cindy Gallois4Malcolm Parker5Sarah Winch6Ben White7Xing Ju Lee8Leonie Callaway9professor of health economics1 Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australiasenior research fellowAustralian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia2 School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia3 Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia3 Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaAustralian Centre for Health Law Research, Queensland University of Technology Faculty of Business and Law, Brisbane, Queensland, AustraliaSchool of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia3 Faculty of Medicine, The University of Queensland, Brisbane, Queensland, AustraliaObjective To quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life.Design Retrospective multicentre cohort study.Setting Three large, metropolitan tertiary hospitals in Australia.Participants 831 adult patients who died as inpatients following admission to the study hospitals over a 6-month period in 2012.Main outcome measures Odds ratios (ORs) of NBT derived from logistic regression models.Results Overall, 103 (12.4%) admissions involved NBTs. Admissions that involved conflict within a patient’s family (OR 8.9, 95% CI 4.1 to 18.9) or conflict within the medical team (OR 6.5, 95% CI 2.4 to 17.8) had the strongest associations with NBTs in the all subsets regression model. A positive association was observed in older patients, with each 10-year increment in age increasing the likelihood of NBT by approximately 50% (OR 1.5, 95% CI 1.2 to 1.9). There was also a statistically significant hospital effect.Conclusions This paper presents the first statistical modelling results to assess the factors associated with NBT in hospital, beyond an intensive care setting. Our findings highlight potential areas for intervention to reduce the likelihood of NBTs.https://bmjopen.bmj.com/content/9/11/e030955.full |
| spellingShingle | Nicholas Graves Hannah Elizabeth Carter Eliana Close Lindy Willmott Cindy Gallois Malcolm Parker Sarah Winch Ben White Xing Ju Lee Leonie Callaway Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia BMJ Open |
| title | Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia |
| title_full | Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia |
| title_fullStr | Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia |
| title_full_unstemmed | Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia |
| title_short | Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia |
| title_sort | factors associated with non beneficial treatments in end of life hospital admissions a multicentre retrospective cohort study in australia |
| url | https://bmjopen.bmj.com/content/9/11/e030955.full |
| work_keys_str_mv | AT nicholasgraves factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT hannahelizabethcarter factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT elianaclose factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT lindywillmott factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT cindygallois factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT malcolmparker factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT sarahwinch factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT benwhite factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT xingjulee factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia AT leoniecallaway factorsassociatedwithnonbeneficialtreatmentsinendoflifehospitaladmissionsamulticentreretrospectivecohortstudyinaustralia |