Care of dying adults in the last days of life

Dr Rachael Marchant RCGP/Marie Curie clinical support fellow for end of life care

It can be very difficult to know for certain that a person is dying. A review of the Liverpool care pathway [PDF] found a lack of clarity in the use of the term "end of life" and inconsistencies in the care those on the pathway received. Since this review NICE have produced guidance NG31 "Care of the dying adult in the last days of life". The title is clear that this is targeted at those in the last days of rather than the wider group who might be on a practice's "palliative support" or "end of life register" who are usually those considered to be in the last year of life using the "surprise question". The RCGP have partnered with Marie Curie on a spotlight project for end of life care and produced Top Tips based on NICE guidance care of dying adults in the last days of life (NG31). This document has been endorsed by RCGP, Marie Curie and NICE and we hope provides a useful resource to support the guidance in this area 

Perhaps one of the more complex areas of the guidance is the advice around hydration and related symptoms. This clearly states that a trial of clinically assisted hydration should be considered if a dying person has distressing symptoms related to dehydration. There is also specific guidance that where clinically assisted hydration is being considered it should be communicated to the dying person and those important to them that it is uncertain if it will prolong life or hasten death and whilst it may relieve distressing symptoms it may cause other problems. It is essential therefore that the multi-disciplinary team caring for a dying person has the skills and capacity within it to facilitate assessment, shared decision making and documentation around this as well as the practical capabilities needed.

The RCGP & Marie Curie Partnership led by clinical champion Catherine Millington-Sanders has also developed the UK General Practice core standards for Advanced Serious Illness and End of Life Care – or 'Daffodil Standards', which will soon be piloted at GP practices throughout the UK. Recognising that practices are all different and have widely varying quality improvement needs, the standards offer a free, evidence-based, peer-reviewed structured approach to quality improvement across eight domains. 

General practice can work with their registered population but also with the wider local community, to connect and build a public health and social medicine approach to end of life care. The Standards support Compassionate Community development and to share lessons learnt from sites revealing the opportunities of this approach, the RCGP & Marie Curie partnership are hosting a Compassionate communities event on the 31 of January 2018 in London.  

Anticipatory care planning

Anticipatory care planning (ACP) helps you capture patient’s preferences about how and where patients want to be treated and supported in the future. It requires practitioners to work with patients and their carers to ensure information is captured the right thing is done at the right time by the right person to achieve the best outcome.

ACP puts people at the centre of the decision-making process about their health and care needs. See our Bright Idea on Anticipatory Care Planning for help on a quick and easily implemented approach to ACP.

Contact

Clinical Innovation and Research Centre: 020 3188 7597
circ@rcgp.org.uk

Find courses & events

The item has been added to your basket.

Continue shopping

Go to basket

This item is out of stock.

Continue shopping

The item is out of stock.

Yes Continue shopping

An error occured adding your item to the basket:

Continue shopping