Caring for dying patients in the community
BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2022-071661 (Published 08 August 2024) Cite this as: BMJ 2024;386:e071661
- Rebecca Holdsworth
, academic general practice trainee1 , - Grace Rowley, consultant in palliative medicine,
- Emma Farrington, trust grade doctor
- 1School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- 2 National Institute of Health and Care Research, London, UK
- 3 North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK
- 4 Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Correspondence to: R Holdsworth rebecca.holdsworth{at}ncl.ac.uk
What you need to know
Recognising when patients are dying can be difficult—clinical and general indicators can help to support decision making and improve quality of life and care for patients in the last days and hours of life
Clear and sensitive communication of dying with patients and relatives can improve quality of care and build trust
Understanding the views of relatives, carers, and others involved in patients’ care can help to recognise when patients are dying
Effective recognition, communication, and management of patients who are dying can greatly benefit patients’ quality of life and bring comfort to their loved ones at this important stage. In the UK, the number of people dying at home is increasing year on year.1 In 2022, almost half of those who died did so either at home or in a care home.2 This article provides practical advice about communicating and planning care at the end of life for patients and families in the community. Box 1 provides key definitions of terms used.
Terms used in the care of dying patients
Palliative care
Palliative care provides relief from pain and other distressing symptoms experienced by people with advanced, progressive illness. Such management aims to support people with active holistic care until death, and help their families to cope with the illness and bereavement34
End of life
The General Medical Council defines end of life in the context of patients who are likely to die within the next 12 months.5 In practice, dying and end of life can be used synonymously, which potentially causes confusion and problems for patients and professionals
Dying
Care of patients in the last days and hours of life should include, but is not limited to, the following areas6: quality of life, physical symptoms, emotional and cognitive symptoms, advance care planning, functional status, spirituality, grief and bereavement, satisfaction, quality of care, and carers’ wellbeing …
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