Professional Practice Assessment: Improving End-of-Life Care Through the Standardization of Treatment Limitation in the Long-Term Care Facilities of a French Hospital.

Abstract

Palliative support has been shown to improve the quality of end-of-life care provided in long-term care facilities (LTCF). In this context, a practice improvement plan, which included creating a withholding and withdrawing life-sustaining treatment (WLST) protocol, has been developed and implemented in our LTCF. We aimed to compare professional practices before and after the implementation of this improvement plan. The study population included all individuals who died in 2018 and in 2021. A clinical audit noted if WLST was decided and which palliative interventions were deployed. WLST decisions were significantly more frequently taken in 2021 than in 2018, with a longer interval between the decisions and death, as well as fewer transfers to acute care facilities. Identifying and managing end-of-life situations more frequently leads to shared WLST decisions, which allow for more effective cessation of interventions and fewer transfers during the last month of life.