CARE AT THE END OF LIFE: A guide to best practice, discussion and decision-making in and around critical care

Published 22/10/2021

CHAPTER 2: The Provision of Care at the End of Life in Critical Care

In the first instance where prognoses are uncertain, combined supportive and active approaches are recommended. This ensures symptom control and simultaneously provides an environment where the possibility of dying can be discussed. It is important that differences between ‘palliative’ treatments (aimed at symptom control in incurable illness, regardless of illness duration) and ‘end of life’ treatments (given during the very last days and hours of life) are made clear to patients and families. Fostering an awareness of dying, whilst balancing hope, is an important part of end-of-life care.

Key Points

  • Effective end-of-life care involves individualised symptom assessment and management.
  • Effective end-of-life care includes a duty to understand patients’ values and beliefs and meet such needs.
  • Involving the family of the dying patient enhances care and experiences.
  • Clear, non-ambiguous communications are essential.
  • The overall aim is to ensure that the patient is the focus of care and allowed to have a dignified, natural death

Recommendations

  • Families should be invited to participate in end-of-life care provision to enhance awareness of dying and develop family-centred care.
  • Best practice for symptom management involves routine assessment with active, rapid responses to symptoms. Care planning with symptom experts (e.g. palliative care) can help optimise control.
  • Individualised risk assessments and clear plans of care, involving patients/families, will improve processes of withdrawal and withholding treatments.
  • Comfort care should take priority with the avoidance of prolongation of dying, tempered with families’ needs regarding time to reach acceptance.
  • Needs assessment should use recognised tools and encompass spiritual, emotional, practical, physical and psychological needs