End-of-life priorities in practice

Emma Hill

doi:10.3399/bjgp15X683425

Following criticism of the Liverpool Care Pathway (LCP) in an independent review in 2013, it was recommended that it be phased out.¹

The Leadership Alliance for the Care of Dying People published a response to that review in June 2014.² This listed five priorities for care, broadly addressing the importance of an individual, holistic approach, with emphasis on communication, listening to the patient, and recognition of impending death.

In general practice, end-of-life care is delivered in the patient’s home, which may be unfamiliar to the doctor, especially out of hours. Time pressure can inevitably increase the stress.

With this in mind, I set out to create a checklist for what GPs actually need to do during the consultation. We often talk about giving the patient TLC, but what does that mean? In this case, it stands for Tailor made, individual care; Listening; and good Communication.

My checklist applies the basic principles of care, but in a structured and practical way. It enables all people involved with the patient, be that a GP, nurse, or carer, to remember the needs of the dying patient and take practical steps to address them, or to ask a clinician to address them:

Is the patient dying in their chosen place of death, if possible?
Is the patient in pain? Is analgesia prescribed, and is it available today?
Is the patient feeling sick or vomiting? Is medication prescribed and available to help with this?
Is the patient agitated? Is medication prescribed and available to help with this?
Have unwanted medications been stopped?
Has a Do Not Resuscitate order been signed, and if so is it available?
Is the patient thirsty? Does their mouth need care?
Are their bladder and bowels comfortable?
Has somebody spoken to the family or other loved ones today?
Are there any other concerns which have not been addressed?

REFERENCES

1.↵
1. Department of Health
(July, 2013) More care, less pathway: a review of the Liverpool care pathway, Independent Review Of The Liverpool Care Pathway. www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf (accessed 9 Jan 2015).
2.↵
(June, 2014) Once chance to get it right: improving people’s experience of care in the last few days and hours of life, Leadership Alliance for the Care of Dying People. www.gov.uk/government/uploads/system/uploads/attachment_data/file/323188/One_chance_to_get_it_right.pdf (accessed 9 Jan 2015).