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A good death is much more than anticipatory drugs

Pablo Millares Martin
British Journal of General Practice 2020; 70 (701): 581-582. DOI: https://doi.org/10.3399/bjgp20X713633
Pablo Millares Martin
Whitehall Surgery, Leeds. Email:
Roles: GP
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It is interesting to read Bowers et al’s article1 as it confirms general practice response in the UK is quite variable as regards end-of-life care. Over a decade ago, the Department of Health published its white paper on End of Life Care Strategy;2 in it, four elements were considered (dignity in treatment, adequate symptom control, familiar surroundings, and people).

To achieve ‘a good death’, having the right conversation is paramount; equally is having adequate coordination among the different professionals looking after the patient, the origin of the Electronic Palliative Care Coordination Systems (EPaCCS) currently in use in different shapes and forms across the UK.3 The ability to have early anticipatory drugs as part of advanced care plans shared among organisations (district nursing, out of hours, GPs) is a core element.4–6

The question is whether anticipatory drugs are the initial step, as it seems implied in the article, or whether it is the careful discussion with patients and families of the end of the road and the planning of all aspects of care, of sharing information, of required coordination, of support available.

The use of anticipatory drugs should not be discussed in isolation. Understanding the patient’s preferences for end-of-life care, including preferred options for the place of care as well as the place of death, and any other personal views, must take place. A coordinated and holistic approach is the only way to achieve a good death.

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Bowers B,
    2. Barclay SS,
    3. Pollock K,
    4. Barclay S
    (2020) GPs’ decisions about prescribing end-of-life anticipatory medications: a qualitative study. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp20X712625.
  2. 2.↵
    1. Department of Health
    (2008) End of life care strategy: promoting high quality care for adults at the end of their life (DH, London) https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life (accessed 10 Nov 2020).
  3. 3.↵
    1. Millares Martin P
    (2017) Electronic palliative care coordination system (EPaCCS): interoperability is a problem. BMJ Support Palliat Care 8, 3, 358–359.
    OpenUrl
  4. 4.↵
    1. Dinnen T,
    2. Williams H,
    3. Yardley S,
    4. et al.
    (2019) Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis. BMJ Support Palliat Care doi:10.1136/bmjspcare-2019-001824. Epub ahead of print.
  5. 5.
    1. Whole Systems Partnership
    (2016) Independent evaluation of Electronic Palliative Care Co-ordination Systems (EPaCCS) in England. Final report, https://www.thewholesystem.co.uk/wp-content/uploads/2015/11/epaccs_evaluation_report_final_march_2016.pdf (accessed 10 Nov 2020).
  6. 6.↵
    1. Allsop MJ,
    2. Kite S,
    3. McDermott S,
    4. et al.
    (2017) Electronic palliative care coordination systems: devising and testing a methodology for evaluating documentation. Palliat Med 31, 5, 475–482.
    OpenUrlPubMed
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British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
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A good death is much more than anticipatory drugs
Pablo Millares Martin
British Journal of General Practice 2020; 70 (701): 581-582. DOI: 10.3399/bjgp20X713633

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A good death is much more than anticipatory drugs
Pablo Millares Martin
British Journal of General Practice 2020; 70 (701): 581-582. DOI: 10.3399/bjgp20X713633
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