Variations in Clinical Practice: Assessing Clinical Care Processes According to Clinical Guidelines in a National Cohort of Hospice Patients.
Everlien de Graaf, Matthew Grant, Frederieke van de Baan and 4 others
PMID 35531900WHAT IT FOUND
In Dutch hospices, only 33% of clinical practices in volunteer-run units met pain, delirium, or palliative sedation guidelines, versus 65% in specialist units.
Medication often matched guidance, but treatment evaluation was much less consistent.
Key findings
01Care met all guideline criteria for 46% of patients treated for pain, 59% of patients treated for delirium, and 48% of patients who underwent palliative sedation.
02Guideline adherence varied by hospice type: 33% of clinical practices in volunteer-run units, 65% in specialist units, and 50% in nursing-home palliative units met all criteria.
03For pain, 91% of patients received medication treatment according to guidelines, but only 49% had routine evaluation after treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study relied on retrospective clinical records, so missing documentation could hide deviations from guidelines. Unclear records were counted as guideline-conformant, so the reported variation is likely an underestimate. Only processes that could be measured from notes were assessed; communication, patient goals, information provision, and many non-medication care elements were not captured. The study described adherence to guidelines, not patient outcomes, so it cannot show whether guideline-conformant care improved survival, comfort, or quality of life. The sample came from 51 selected hospices and a limited number of patients per site, and paediatric hospices were excluded. Hospice type was associated with adherence, but the study did not test the reasons for variation.
The easy way to misread this
Do not read the 33% figure as proof that volunteer-run hospices deliver worse care. It reflects only the documented guideline criteria that could be measured from records, and unclear records were counted as guideline-conformant.