Recognising and managing key transitions in end of life careBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4863 (Published 16 September 2010) Cite this as: BMJ 2010;341:c4863
- Kirsty Boyd, consultant in palliative medicine,
- Scott A Murray, St Columba’s Hospice professor of primary palliative care
- 1Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh
- Correspondence to: K Boyd
- Accepted 15 May 2010
Palliative care is being introduced earlier in the trajectory of illness, often in parallel with disease modifying treatment. A care pathway that starts with the identification of people approaching the end of life and initiating discussions about their preferences is central to the end of life care strategy in England.1 The Scottish government action plan also advocates a person centred approach based not on diagnosis or prognosis, but on the needs of patients and carers in all care settings—home, care home, and hospital.2 These needs include information about the illness and prognosis, symptom control, attention to psychological and spiritual concerns, continuity of care, and practical support. In view of the increasing numbers of people who could benefit, the emphasis of the UK strategies is on improving end of life care delivered by primary care teams, hospital staff, and social care services. Specialist palliative care should be available to people in any care setting who need additional expertise, and it serves most effectively as a resource to support ongoing care by other clinical teams.3
In economically developed countries, most people now die from one or more complex long term conditions.4 End of life care encompasses three overlapping phases of illness (figure)⇓. In this article we offer guidance about recognising end of life transitions. We also consider the challenge of changing the goals of care in patients with slowly progressive or fluctuating long term conditions.
Transition 1: would my patient benefit from supportive and palliative care?
Managing the transition to supportive and palliative care is arguably more of a challenge than identifying people who are …