Royal College of Physicians of London

"30% of acute inpatients are in their last year of life, but it can be difficult to deliver high-quality end-of-life care in acute environments, despite the commitment and willingness of staff to do so. This resource is designed to support acute and general physicians in the care and choices they provide to patients in the acute care setting who are approaching or at the end of their life. End-of-life (EOL) care for patients should be individualised. Patients’ choices are supported when there is excellent holistic care, and sensitive and honest communication with patients, families and between all members of staff and the teams caring for them. In acute settings, active treatment is often the default course of action, such that busy teams may find it difficult to pause and recognise that someone is dying until that person reaches their final hours or days. This resource supports physicians to identify patients in the acute setting who are dying, to start EOL conversations with patients, families and carers, and to recognise that every patient will have different priorities in how their EOL care is managed."… (mais)

There is an increasing recognition that the principles of palliative care medicine can be implemented beneficially across most of the NHS and within most specialties. This report therefore reflects the shift in practice from predominantly cancer care to a much broader application. It includes recommendations on disseminating best practice both for those with terminal illness and for those with incurable illness earlier in the disease trajectory. Looking to the future, there is specific consideration of changing demographics, the importance of interdisciplinary care, the dissemination of care pathways, and new funding models. Palliative care deals with an area of modern medicine that raises many ethical dilemmas, both in respect of treatment decisions and the formidable obstacles in undertaking research. For although palliative care is generally considered a 'good thing', it should be subject to rigorous scrutiny and justification of both process and fundemental precepts. The report is both philosophical and practical and will be relevant to all doctors and allied healthcare professionals who wish to ensure that the needs of patients and their carers properly met. It is essential reading for healthcare planners, commissioners of palliative care services, and for providers of undergraduate and postgraduate education for all doctors.… (mais)

Feeding is basic to life but it can also be an artificial medical procedure in the power of health professionals. Sometimes it causes dilemmas and strong differences of opinion between patients, relatives and professionals. This report is the result. It acknowledges the confusion and uncertainty that sometimes surround decision-making and practice, including the difficulties of carrying out some of the technical interventions involved. The report provides evidence-based guidance on the mechanisms and techniques of oral and artificial nutrition in health and disease. It sets out the ethical and legal concerns that provide the framework for decision-making. Case studies then illustrate dilemmas and solutions, for example on deciding whether to withhold or provide artificial nutrition. This guide is essential reading for all those involved in caring for people who have nutritional and oral feeding difficulties. [source: book cover]… (mais)