End-of-life care- includes physical, emotional, social, and spiritual 3 TRIGGERS THAT SUGGEST PATIENTS ARE NEARING THE

RING THE END-

support for patients and their families. OF-LIFE (According to Guidance)

• GOAL: end-of-life care is to control pain and other symptoms so Trigger 1 – The surprise question.
the patient can be as comfortable as possible. Trigger 2 – General indicators of decline.
Trigger 3 – Specific clinical indicators related to certain conditions
TERMINAL CARE
• Death is not a failure of modern medicine but as inevitable as ever it PALLIATIVE CARE
was
• "And one day, I too shall face death and not as a stranger” Care Decisions
▪ Including open discussions about treatment options when
KEY TASKS
diagnosed with a serious or chronic illness and the importance of
'7 Cs'
Advance Care Planning
1. Communication
2. Co-ordination
Addressing Overwhelming Symptoms
3. Control of symptoms
4. Continuity including out of hours ▪ For example: Pain, SOB, fatigue, nausea, loss of appetite, and
5. Continued learning difficulty sleeping
6. Career support
7. Care in the dying phase Recognizing Psychosocial Distress
▪ May include anxiety, depression, fears, and spiritual decision
AIM OF TERMINAL CARE
▪ Provide constant and safe symptomatic treatment that respects your Emphasizing YOU
client’s dignity and individuality ▪ With a focus on the entire person including family
▪ It also takes into account patients’ loved ones

• General Medical Council (GMC) has published guidance

'Treatment and care towards the end of life: good practice in
decision making” While the document should be read in its entirety,
salient points are as follows:

o Care should be equitable. Capacity and human rights legislation

should be borne in mind.

o All reasonable steps should be taken to prolong a patient's life

but there is no absolute obligation to prolong life irrespective of
the consequences for the patient or the patient's views.

o Every adult patient should be presumed to have the capacity to

make decisions about their care and treatment unless proved
otherwise.

o If an adult patient lacks capacity, the decisions made on the

patient's behalf must be based on whether treatment would be of
overall benefit (including the option not to treat) in consultation
with those close to the patient.

o Different decision-making paths should be followed for patients

who have capacity and those who do not (full details are
provided in the GMC guidance)

Gold Standard Framework (GSF)

Prognostic Indicator Guidance

PROGNOSIS
-A medical prediction of the future course of a disease and
the chance for recovery

• The Guidance promotes earlier identification of people nearing the

end of life, and the subsequent inclusion of their preferences for end-
of-life care on the End-of-Life Register.
o This leads to earlier planning and better coordinated care, which
aims to meet their individual preferences for end-of-life care,
including the preferred place of care.

• The philosophy of the Guidance is one of predicting needs rather

than exact prognostication. The information includes a definition of
end-of-life care (GMC 2010)

1 DELFINO