Life-affirmation strategy improves quality of end-of-life journey after hospital death

Abstract Description

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Authors (including presenting author) :

Lau TWS (1), Chan GSW (1), Yip HY (1), Poon JCK (1), Tsang GKF (2), Yip WPW (2), Beh PSL (3)

Affiliation :

(1) Department of Pathology, (2) Administrative Services Department, Queen Mary Hospital, (3) Department of Pathology, LKS Faculty of Medicine, The University of Hong Kong

Introduction :

Hospital mortuaries manage over 80% of deaths in Hong Kong. Subsequent to a satisfaction survey on the end-of-life journey after hospital death which was carried out in 2015 (see reference), a life-affirmation strategy was reinforced in Queen Mary Hospital mortuary, in parallel with hospital redevelopment plans. It was based on a person-centered approach, which included establishment of a ‘healing environment’, enhanced provision of death information to next-of-kin and death education for mortuary staff, amongst others. A survey was performed in 2018 to assess the effectiveness of the life-affirmation strategy in improving the next-of-kin experience.

Objectives :

(1) To gauge the effectiveness of the life-affirmation strategy by comparing with 2015 survey; (2) To identify areas for improvement in end-of-life care.

Methodology :

Next-of-kin who collected body in the ‘Bereavement Suite and Mortuary’ at Queen Mary Hospital between June and November 2018 was invited to participate in a semi-structured interview. The satisfaction score, needs and expectations of next-of-kin were compared with the 2015 survey.

Result & Outcome :

205 next-of-kin completed the survey. The overall experience improved significantly compared with 2015. The greatest increase in satisfaction score was achieved in the mortuary environment (4.28 vs 3.29, p< 0.001), attitude of mortuary staff (4.20 vs 3.54, p< 0.001) and body viewing arrangement in the mortuary (4.08 vs 3.48, p< 0.001). The perception of body condition was significantly improved (3.74 vs 3.38, p< 0.005). The perceived need for psychosocial support and improvement of the end-of-life care deceased (p< 0.0001). Only 34% of participants felt that the directions to the mortuary were adequate. ‘Explanation given by the physician about the death’ and ‘duration of bedside stay after death’, which scored lowest amongst all parameters, did not show significant improvement. CONCLUSIONS: The life-affirmation strategy can be practically applied and is highly effective in enhancing the end-of-life experience for next-of-kin. Areas for improvement include explanation by the physician on death circumstances, duration of bedside stay and directions to the mortuary. A paradigm shift from dead body management to a person-centered approach (life-affirmation) is an important strategy that improves end-of-life care and modernising mortuary service. REFERENCE: Ma H et al. Hospital care during the end-of-life journey: a survey of next of kin in the mortuary of a public hospital in Hong Kong. Asian J Gerontol Geriatr 2017; 12:5-10.