• Dirk Houttekier, Frederika E Witkamp, Lia van Zuylen, Carin C D van der Rijt, and Agnes van der Heide.
• 1 End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University , Brussels, Belgium .
• J Palliat Med. 2014 Nov 1;17(11):1238-43.

BackgroundIn hospitals, where care is focused on cure and life prolongation, impending death is often recognized too late. Physician awareness of impending death is a prerequisite for communication with patients and relatives about dying in hospital and providing care that adequately addresses patients' needs.ObjectiveTo examine to what extent physicians are aware of the impending death of their dying patients and if awareness is related with communication and medical care, with quality of life in the last 3 days and quality of dying.DesignRetrospective survey among hospital physicians after patient deaths.Setting/SubjectsPatients who died between June 2009 and February 2011 at Erasmus University Medical Center (Rotterdam, The Netherlands).MeasurementsPhysician self-reported awareness of impending death, communication with patients and relatives, medical care, quality of life in the last 3 days, and quality of dying.ResultsThe response rate was 44% (n=228). Physicians reported that they had been aware of the impending death in 67% of their dying patients. If they had been aware, discussing death with patients and relatives was more likely, as well as changing the treatment goal into comfort care or withholding treatment and prescribing opioids in the last 3 days of life. When physicians had been aware of impending death, they rated the quality of dying higher.ConclusionsIn two-thirds of deaths, hospital physicians had been aware of impending death of their dying patients. Physician awareness was related with more communication and more appropriate care in the last days of life.

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