Caring for a dying patient in hospital

Abstract

This series aims to help junior doctors in their daily tasks and is based on selected topics from the UK core curriculum for foundation years 1 and 2, the first two years after graduation from medical school.Every year, more than half a million people die in the United Kingdom, and over half of these deaths occur in hospital. Junior doctors are often required to care for dying patients, 1 and assessment and management of these patients are essential skills. [2][3][4] The importance of good end of life care, both for the patient and for their family, is increasingly recognised. However, many people dying in hospital continue to have unmet needs, and, in the UK more than half of complaints referred to the Healthcare Commission (the Care Quality Commission's predecessor) concerned the care of dying people. 5 Acquisition of the basic skills required to care for people who are dying can improve the patient's and their family's experience of death, as well as the safety, efficiency, and satisfaction of the junior doctor's work. PRACTICE Key pointsJunior doctors are often required to care for dying patients Early recognition of dying facilitates meeting patients' and relatives' preferences for end of life care Communication is the cornerstone of good end of life careThe principles of end of life prescribing are: to stop non-essential drugs; convert essential drugs to the subcutaneous route; and use anticipatory prescribing Cite this as: BMJ 2013;346:f2174

The importance of identifying preferred place of death

“…Although these two pathways are distinctly different, this is not always recognised reflecting the importance of ongoing education provision by specialist services. Pathways acting as frameworks of good practice are useful tools to guide end-of-life care for generalist professionals providing care in any environment 16. End-of-life care is theoretically a less frequent experience for the generalist in comparison to the specialist working in this area, and it is not possible to draw any conclusions from the lack of its use in this service evaluation.…”

“…The absence of medication was not identified as a precipitant during this 5-year period, indeed the majority of home deaths did have anticipatory medication in place. Many different systems exist across the UK,1 9 16 using a framework to support best practice appears effective in achieving quality and location of death, for example, in care homes 17. The University Health Board supports designated pharmacists in each locality to stock such anticipatory medication to avoid delays in access.…”

Dying in the Hospital: What Happens and What Matters, According to Bereaved Relatives

“…In the hospital setting, where care is typically focused on prolonging life, it is often difficult to identify in advance those patients who are unlikely to recover from a worsening condition. 44 However, in a parallel study in the same population, physicians had been aware of the patient's imminent death in 79% of cases. 45 The difference between physician's awareness and relative's and patient's awareness might be correlated with problematic communication but also to variation in the interpretation of what ''imminent death'' entails.…”

No Palco Da Vida, a Morte Em Cena: As Repercussões Da Terminalidade Em Uti Para a Família E Para a Equipe Médica

“…Aspectos considerados importantes no processo comunicacional são citados pelos entrevistados, como o fornecimento de informações claras, honestas e realistas; o respeito às emoções e sentimentos suscitados por esta situação; ter boa capacidade de ouvir; evitar excessos no uso da linguagem técnica e do jargão médico e ter tempo e disponibilidade para conversar com a família sempre que esta demandar atenção ou apresentar dúvidas (SOARES, 2007;SCHAEFER & BLOCK, 2009;SANTOS & BASSITT, 2011;SLEEMAN & COLLIS, 2013). Sobre este último aspecto, a médica 6 aponta uma dificuldade -a impossibilidade de estar disponível sempre que a família demandar.…”

“…O prognóstico deve ser informado para dar tempo para a família se preparar e dizer adeus a seu ente querido. Uma comunicação empática, efetiva e afetiva com as famílias de pacientes em situação de terminalidade pressupõe também que os médicos tenham tempo e disponibilidade para conversar com os familiares sempre que estes demandarem atenção ou apresentarem dúvidas, e que tenham boa capacidade de escuta (SOARES, 2007;SCHAEFER & BLOCK, 2009;NELSON et al, 2010;SANTOS & BASSITT, 2011;SLEEMAN & COLLIS, 2013 O cuidado e o amparo fornecidos pelos médicos-assistentes em nossa pesquisa foram fundamentais para que os familiares entrevistados pudessem se preparar para a morte de seu familiar, mesmo sendo uma experiência penosa, dolorosa e adversa. Entretanto, encontramos também a percepção de que a comunicação foi deficitária, pela falta de clareza, de objetividade e de preparo emocional dos médicos.…”