Rapid Clinical Updates: End-of-Life Care in the Hospital-Handout

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This document provides rapid clinical updates on End-of-Life (EOL) care in hospital settings, emphasizing the importance of timely, goal-concordant discussions and symptom management for seriously ill patients.<br /><br />A key concern is the mismatch between patients’ end-of-life care preferences and actual experiences; for example, 70% of Americans prefer to die at home, yet only 30% do. Hospitalists frequently care for seriously ill patients near the end of life and must proactively identify those with poor prognosis—using indicators like hospital readmissions and declining function—to initiate early palliative care and serious illness conversations. These discussions, which can be learned through established frameworks, should include honest prognostication without diminishing hope. Poor communication risks misunderstanding and loss of trust; tools such as the Serious Illness Conversation Guide (available online) can improve these interactions.<br /><br />In terms of symptom management, EOL care involves tailored relief of distressing physical symptoms (pain, dyspnea), along with addressing emotional, social, and spiritual needs. For patients with months to live, medication regimens should be adjusted based on clinical judgment, with emphasis on deprescribing non-essential drugs as prognosis worsens. Clinicians should not hesitate to start or titrate short-acting opioids even in opioid-naïve patients. In the final hours to days, pain and dyspnea treatments are best delivered as needed bolus doses rather than continuous infusions.<br /><br />The guidance is informed by recent literature on hope and illness expectations, code status conversations, deprescribing, and prognosis prediction, highlighting evolving best practices to ensure patient-centered, dignity-preserving EOL care in hospital environments.<br /><br />Last updated August 2025.

Keywords

end-of-life care

hospital settings

goal-concordant discussions

symptom management

seriously ill patients

palliative care

serious illness conversations

prognostication

deprescribing

opioid management