Care of the dying patient: the last hours or days of life

The impact of death in our society is easily underestimated. National events sometimes provide a timely reminder of the power and influence of a dignified death and the profound effect it has on the family and those close to the person who has died. Evidence based guidelines now exist to help with the care of people who are dying, including guidelines for symptom control, psychosocial support, and bereavement care.1–3 None the less, highly publicised cases continue to occur of patients dying in distress with uncontrolled symptoms and relatives being unsupported at this vulnerable time in their lives.4 Ensuring a good death for all is therefore a major challenge not only for healthcare professionals but also for society.

Mortality data for the United Kingdom show that 608 000 people died in 2000; 25% of these deaths were from cancer, 17% from respiratory disease, and 26% from heart disease.5 The table gives a breakdown of place of death for all dying patients and those dying from cancer. The modern hospice movement was established in response to the poor quality of care of the dying patient.6 The hospice model of care is now espoused as a model of excellence and has led to a worldwide hospice movement aspiring to deliver high quality care to dying patients. Palliative care services deliver direct patient care and also have an advisory and educational role to influence the quality of care in the community and in hospitals. The major challenge is to transfer best practice from a hospice setting to other care settings and to non-cancer patients. …