End-of-life care practices among internal medicine inpatient deaths in 2014 and 2023: a retrospective comparative study

Patients admitted under internal medicine frequently have advanced multimorbidity, high healthcare utilisation and palliative care needs. We compared two cohorts of internal medicine inpatient deaths nearly a decade apart to examine differences in patient characteristics, healthcare utilisation and end-of-life care practices. We retrospectively reviewed 50 consecutive inpatient deaths under the Department of Internal Medicine at Singapore General Hospital during June–July 2023 and compared them with 50 consecutive inpatient deaths from July–August 2014. Demographic characteristics, healthcare utilisation, documented end-of-life care practices and inpatient palliative medicine referral were compared. The 2023 cohort had poorer documented premorbid functional status, with more patients requiring assistance with activities of daily living (26% in 2014 vs. 52% in 2023, p = 0.013) and a greater proportion who were homebound (8.5% in 2014 vs. 44% in 2023, p = 0.001). No statistically significant differences were observed in healthcare utilisation between cohorts. Inotropic support was less frequently used in 2023 (18% in 2014 vs. 2% in 2023, p = 0.008), whereas medical social work referral was more frequent (18% in 2014 vs. 40% in 2023, p = 0.015). Inpatient palliative medicine referral was numerically lower (32% in 2014 vs. 16% in 2023, p = 0.061). Documented goals-of-care discussions remained common in both cohorts, although only 16% of patients in 2023 had documented advance care planning. This study provides contemporary insights into end-of-life care practices among patients who died under internal medicine at a tertiary hospital in Singapore. The findings describe differences in patient characteristics and selected end-of-life care practices between two cohorts nearly a decade apart and identify important areas for future investigation, including multidisciplinary care, palliative medicine referral practices, and advance care planning. Larger prospective multicentre studies incorporating community-based palliative care data, standardised measures of functional status, and adjustment for case mix are needed to better inform future end-of-life care delivery.