A good death is much more than anticipatory drugs

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