• ‘End of life’ (EOL) is last year of life (DH 2008)
• not confined to terminal phase (last days of life)
• Identify patients approaching EOL early to plan appropriate care and treatment

Triggers for EOL

• Ask the surprise question – ‘Would you be surprised if the patient died in the next 6–12 months’?
• Does the patient have general indicators of decline?
• Does the patient have specific clinical indicators?

1 year-advancing disease

Actions required

• Contact GP to update and recommend addition to Gold standards framework GSF register
• every GP practice has a GSF register of EOL patients to enable community teams to identify, monitor and plan the care of these patients
• Refer to district nurses

Also consider

• Referral to community palliative care service
• Community palliative care services provide
  • holistic assessment of patients at home
  • symptom management
  • psychological support
• ReSPECT form containing
  • resuscitation status
  • treatment escalation/limitation plan
  • wishes and preferences of patient
• Recommend a DS1500
  • the DS1500 is a short medical report for patients with a life expectancy under 6 months
  • it supports them to claim rapid access to financial benefits
  • these reports are most often completed by the patient’s GP or specialist nurse

6 months-increasing decline

Actions required

• Contact GP to confirm patient on GSF register
• Refer to community palliative care service
• Refer to district nurses
• ReSPECT form containing
• resuscitation status
• treatment escalation/limitation plan
• wishes and preferences of patient
• Review unnecessary medication
• Utilise palliative discharge pathway where necessary
• Recommend a DS1500

Last days of life

Actions required

• Follow last days of life guideline

First days after death

Actions required

• Prompt verification of death
• Carry out personal care after death
• Allow adequate time to support family and carers
• Provide Trust bereavement booklet
• Refer to local bereavement support if needed
• Inform bereavement services