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December 2011
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Chemotherapy: Putting Patient Safety First
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NCEPOD report: For better, for worse?
Some difficult questions were posed when NCEPOD looked at the final 30 days of life among patients who died following administration of SACT (in England, Wales and Northern Ireland; summer 2006). However, as NCEPOD chair, Professor Tom Treasure comments in his foreword to the report, For better, for worse?, questions, no matter how difficult, must be asked, or else remain unanswered—hence NCEPOD’s decision to pursue its enquiry into deaths post-SACT.
Unfortunately, NCEPOD has not been able to formulate a complete picture of the circumstances surrounding deaths in the 30 days following SACT during the study period. The return rate of questionnaires (63%) and case notes (52%) fell far short of the usual NCEPOD participation level of over 80%. A few clinicians were resistant to the enquiry, saying that no-one, except the doctor in charge of each case, is in a position to judge the appropriateness of care.
However, the heavy workload of the thinly spread oncology workforce was also considered to play a part in the shortfall of returns. It is also possible that some of the questionnaires may not have reached the intended consultants (this is the first time that NCEPOD has looked at medical/clinical oncology).
That said, this is the first NCEPOD enquiry to find that instances of good practice (35% of the cases reported) were outnumbered by cases where management was deemed by the assessors to leave room for improvement (49%). In 8% of cases, the care provided was judged to be ‘well below an acceptable standard’. Moreover, looking at the last course of chemotherapy given before the patient died, the final decision to treat was inappropriate in 19% of cases, according to the assessors.
Many more instances of less than good practice are itemised in the full report, which can be downloaded at http://www.ncepod.org.uk/2008sact.htm. A few key examples, along with the corresponding NCEPOD recommendations, are listed in Table 1.
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Discussion.