Palliative care is provided over a long period of time in parallel with curative interventions but sooner or later a breakpoint occurs when curative treatment no longer has an effect. A new state enters and the patients need a palliative breakpoint conversation (PBC). This requires a medical assessment and should be documented in the patients record. PBC are often conducted as a response to patient´s unexpected deterioration or not at all. According to the Swedish Register of Palliative Care (SRPC) about 27 000 patients in hospitals (year 2014-2017) did not receive PBC and 50 % of all patients (N=500 000) PBC were not documented.
Aim: To explore the proportion of patients in all clinical units in Sweden that did not receive PBC documented in the medical records.
Methods: All clinical units N=6000 in the SRPC that collects data from hospitals, hospices, nursing homes and home care, with an end-of-life questionnaire about palliative care content focusing on the last week of life will be included. We will explore what units documented PBC (answered yes in the questionnaire) or not documented PBC (answered no in the questionnaire). Data analysis is under progress with statistical analysis, and preliminary results will be presented at the conference.
Outcomes: Patients that do not receive PBC may suffer in a greater extent, in comparison with those who get PBC, from pain and other symptoms and have less frequent access to drugs for pain, anxiety and nausea. They die with parenteral nutritional treatment and with pressure ulcers. Patients don't die where they prefer and they die alone. Their relatives don't receive information and are not offered bereavement support.
Discussion: Insufficient documentation about PBC may bring about unnecessary unclarity on how to care for the patient, this uncertainty can be perceived as confusing for both patient and family. A PBC late in the disease can also impair the patients ability to participate in decision-making.