Discussing and planning care for people approaching the end of their life

Abstract

The National End of Life Strategy1 and National Institute of Health and Care Excellence (NICE) Quality Standard2 recommend that, as the end of life approaches, patients have open and honest discussions with healthcare professionals1,2 and are given the opportunity to plan aspects of their care in accordance with their needs and preferences.1–3 Despite evidence that discussions and better planning of care can improve the patient's quality of life4 and increase carer satisfaction,5 many patients continue to die without having had these discussions.6,7 Guidance issued by the General Medical Council (GMC)3 is clear that every clinician has the responsibility to consider and act on end-of-life issues in appropriate patients. However, physicians are not always confident about how to initiate discussions about end-of-life issues.6 Here, we highlight ways to help engage patients and their families and/or carers in discussions about the end of their life and, when appropriate, to plan aspects of their care.3 Patients can be considered to be approaching the end of their life when they might die within the next 12 months because of a deterioration in a serious chronic health problem, including frailty, or they have a life-threatening acute event, or they have a serious underlying condition that puts them at risk of sudden death.3 However, the term ‘end of life’ if used in discussion with patients and families, usually erroneously, conveys a sense of dying being imminent. What is important in such discussions is the opportunity for sharing information about deteriorating health, their risk of dying at some point that remains uncertain and holistic assessment of unmet supportive and palliative care needs. This should, if the patient and family wish it, include future care planning.