End of life care

Question 1

what is end of life care?

Answer 1

Patients are ‘approaching the end of life’ when they are likely to die within the next 12 months. - GMC: Treatment and Care towards the end of Life: Decision Making 2010 (6)

Would you be surprised if Mrs A were to die within the next 12/12? - Gold Standards Framework (2011)

Question 2

what are some signs someone is entering the final phase of life?

Answer 2

• Cheyne-Stokes respiratory pattern
• Shallow breathing
• Use of accessory muscles of respiration
• Respiratory secretions
• Skin colour changes
• Temperature changes at extremities
• Decreasing levels of consciousness leading to coma
• Agitation/restlessness
• Decreased urine output/ incontinence
• Decreased/Absent oral intake
• Difficulty swallowing

Question 3

what are the 5 common symptoms in dying and what are the anticipatory medications?

Answer 3

Question 4

what are some things done to care for patients in the last days of life?

Answer 4

mouth care

positioning

supported with food and drink as much as they want

Question 5

what factors may indicate dying is imminent?

Answer 5

• Bedbound
• Drowsiness, impaired cognition
• Difficulty taking oral medications
• Reduced food and fluid intake
• Increasing symptom burden

Question 6

what can be done to support peoples hydration at the end of life?

Answer 6

• Offer good mouth care
• Assess daily re hydration status
• Discuss risks and benefits of CAH; may relieve symptoms secondary to dehydration, but may cause other problems.
• Share uncertainty around whether CAH will prolong life or extend the dying process.
• No clear evidence that not giving CAH hastens death