End-of-life care: preparing patients and families

Abstract

The priority for care at the end of life is to ensure that all patients experience high-quality care, irrespective of their diagnosis or preferred place of care. This phase of an individual's disease journey is fraught with complex decision-making that can obscure and impair the provision of high-quality care in the absence of advance care planning. In the past few years, the Department of Health in the UK has emphasized this through a number of initiatives and strategies aimed at preparing patients, carers, and indeed professionals, for the terminal phase of disease. This Review explores these initiatives and demonstrates, through the discussion of a recent case history of an individual with a diagnosis of a urological malignancy, how they have been implemented at a local level by The Royal Marsden NHS Foundation Trust.

Key Points

• The priority for care at the end of life is to ensure that all patients experience high-quality care, irrespective of their diagnosis or preferred place of care

• The Department of Health in the UK has issued a number of initiatives and strategies aimed at preparing patients and carers for the terminal phase of disease

• The End of Life Care Strategy emphasizes a coordinated pathway approach

• The Hospital2Home project at The Royal Marsden NHS Foundation Trust aims to reduce unnecessary hospital admissions and increase the proportion of patients dying in their preferred place

• The Department of Health is currently developing a locality-wide, end-of-life register to further improve communication about end-of-life care preferences between health-care settings