What does high quality end of life care look like?
In England and Wales
In 2014, the Leadership Alliance for the Care of Dying People published a new approach to caring for people in the last few days and hours of life. It focuses on the needs and wishes of the dying person and those closest to them in planning and delivering care, wherever that may be.
The five priorities for care
The five priorities for care can be used as a guide for providing the best possible care for people with terminal illnesses and their families.
When it is thought that a person may die within the next few days or hours:
- This possibility is recognised and communicated clearly, decisions made and actions taken in accordance with the person's needs and wishes, and these are regularly reviewed and decisions revised accordingly.
- Sensitive communication takes place between staff and the dying person, and those identified as important to them.
- The dying person, and those identified as important to them, are involved in decisions about treatment and care to the extent that the dying person wants.
- The needs of families and others identified as important to the dying person are actively explored, respected and met as far as possible.
- An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, coordinated and delivered with compassion.
Health and care providers across Scotland are committed to the provision of consistently high quality end of life care for all that reflects the four principles set out in the guidance Caring for people in the last days and hours of life, published at the end of 2013:
Principle 1: Informative, timely and sensitive communication is an essential component of each individual person's care.
Principle 2: Significant decisions about a person's care, including diagnosing dying, are made on the basis of multi-disciplinary discussion.
Principle 3: Each individual person's physical, psychological, social and spiritual needs are recognised and addressed as far as is possible.
Principle 4: Consideration is given to the wellbeing of relatives or carers attending the person.
In Northern Ireland
In 2014, what was then the Department for Health, Social Services and Public Safety set out five key principles that should underpin quality for care in the final days and hours of life:
1. There should be timely identification that a person is dying and is probably in the final days and hours of life.
2. Sensitive and clear communication should be at the centre of quality care.
3. People who are identified as dying should have their physical, psychological, spiritual and social needs identified and be involved in decisions about how those needs can best be met. The person’s needs should be regularly reviewed and re-assessed throughout the last days and hours of life.
4. Care in the last days and hours of life should be planned and co-ordinated with a focus on symptom control, comfort management and ensuring that psychological, social and spiritual support is provided to meet the person’s needs.
5. Support for family and carers should be provided during their loved one’s last days and into bereavement.
The Department for Health expanded on these principles in 2016 and further guidance is awaited.
Points to remember
- End of life care should be person-centred.
- In England and Wales, the five priorities for care can be used as a guide for providing high quality end of life care.
- In Scotland, it is important to refer to the Caring for people in the last days and hours of life guidance.
- In Northern Ireland there are five key principles that should underpin quality for care in the final days and hours of life.
- Effective communication is very important.
- Don’t be afraid to talk about death and dying.
- All patients approaching the end of their life should be offered an advance care plan.
- Identify who is part of the multidisciplinary team and what their role is in the patient’s care.
- Look after your own physical and mental health.
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