The Royal College of Physicians has produced a resource in collaboration with the Society for Acute Medicine to support hospital doctors in improving the care and choices provided to people at the end of their life.
The End-of-life care in the acute care setting resource aims to help hospital doctors identify those patients who are in their last days or weeks of life and ensure that their patients’ choices are heard and supported, in a holistic and sensitive way. It provides guidance on starting the often-difficult conversation about end-of-life (EOL) care with patients and their families or carers, recognising that every patient will have different needs and priorities.
This resource provides:
- guidance on how to identify people in the last year of their life
- suggestions for starting a conversation about EOL care
- the role of advance care planning and specialist palliative care
- advice on clinical management and anticipatory prescribing for the dying patient
- recommendations for professional development in EOL care
- an addendum on care of the dying patient with COVID-19.
Identifying that someone is approaching the end of their life is challenging, as is offering them and those close to them a conversation about treatment choices for the future and different options for care. As a result, people with long-term conditions can be admitted repeatedly to hospital, although this may not be what they would want if asked.
The majority of patients who express a preference would prefer to die at home, but currently only 45% of people at the end of their life die in their usual place of residence.
Dr Sarah Cox, lead clinician for the end-of-life care resource, said: “We know that around 30% of hospital inpatients are in their last years of life, and yet in a busy hospital setting, it can be hard to identify when a patient is at the point of needing end-of-life care.
“This resource was produced with that in mind, aiming to equip doctors with the tools needed to identify patients in those last days or weeks of life, and to have open and honest conversations with them about the care they want to receive.
“This is an area of healthcare which is also in need of change in attitude and culture. Death should not always be equated with failure, but rather as a natural process.”
Dr Nick Scriven, immediate past president of the Society for Acute Medicine (SAM), said: “SAM was more than happy to participate in writing these new guidelines and endorsing them as we in acute medicine all too frequently have patients admitted to our units who are in the last hours, days or weeks of life, a stage that has previously either not been recognised or acted upon with proactive planning to the detriment of their care and wellbeing.
“This tool will not only give advice to health care professionals on identifying this stage and managing those difficult decisions and conversations but also offers practical advice for helping manage symptoms that cause distress and can be tricky to solve especially in an acute setting.”