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Published Online: 22 December 2006

The Turning Point: Clinical Identification of Dying and Reorientation of Care

Publication: Journal of Palliative Medicine
Volume 9, Issue Number 6

Abstract

Palliative care is increasingly organized within the setting of formal health care systems but the demarcation has become unclear between, on the one hand, care directed at cure and rehabilitation and palliative care aimed at relief of suffering on the other. With the purpose to increase the understanding about the turning point reflecting identification of dying and reorientation of care, this study explores this phenomenon as determined from health care records of a representative sample (n = 229). A turning point was identified in 160 records. Presence of circulatory diseases, sporadic confinement to bed, and deterioration of condition had a significant impact upon the incidence of such turning point. The time interval between the turning point and actual death ranged between one and 210 days. Thirty percent of these turning points were documented within the last day of life, 33% during the last 2–7 days, 19.5% during the last 8–30 days, 13% during the last 31–90 days, and 4.5% during the last 91–210 days of life. The time interval between the turning point and actual death was significantly longer among individuals with neoplasm(s) and significantly shorter among individuals suffering from musculoskeletal diseases. Perhaps this reflects a discrepancy between the ideals of palliative care, and a misinterpretation of the meaning of palliative care in everyday clinical practice. The findings underscore that improvement in timing of clinical identification of dying and reorientation of care will likely favour a shift from life-extending care to palliative care.

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cover image Journal of Palliative Medicine
Journal of Palliative Medicine
Volume 9Issue Number 6December 2006
Pages: 1348 - 1358
PubMed: 17187543

History

Published online: 22 December 2006
Published in print: December 2006

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Eva Jakobsson
Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
School of Life Sciences, University of Skövde, Skövde, Sweden.
Ingrid Bergh
School of Life Sciences, University of Skövde, Skövde, Sweden.
Fannie Gaston-Johansson
Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborg University, Institute of Nursing, Gothenburg, Sweden.
Carl-Magnus Stolt
Centre of Bioethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
Joakim Öhlén
Faculty of Health Caring Sciences, The Sahlgrenska Academy at Göteborgs University, Institute of Nursing, Gothenburg, Sweden.

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