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Palliative cancer care - general issues - Management
What are important issues to address in community palliative care?

  • The National Institute for Health and Clinical Excellence has outlined key components for best practice in community palliative care.
    • People needing palliative care are identified according to agreed criteria, and a management plan is discussed within the multidisciplinary team.
    • These people and their carers are regularly assessed using agreed assessment tools.
    • Anticipated needs are noted, planned for, and addressed.
    • Patient and carer needs are communicated within the team and to specialist colleagues, as appropriate.
    • Interventions which may be considered or undertaken in an emergency, such as cardiopulmonary resuscitation (CPR), are discussed and noted in advance, where appropriate.
    • Preferred place of care and place of death are discussed and noted, and measures taken to comply, where possible.
    • Coordination of care is orchestrated by a named person in a practice team.
    • Relevant information is passed to those providing out-of-hours care, and anticipated prescribed drugs are left in the home.
    • A protocol for care in the dying phase is followed, such as the Liverpool Care Pathway for the Dying Patient or the Welsh Integrated Care Pathway for the last two days of life.
    • Carers are educated, enabled, and supported, which includes the provision of specific information, financial advice, and bereavement care.
    • Audit, reflective practice, development of practice protocols, and targeted learning are encouraged as part of personal, practice and provider organization development plans.
  • The General Medical Council provides advice and information about these issues, and also what to do if:
    • The person accepts or refuses a treatment option for a reason that may seem irrational to a doctor, or for no reason at all.
    • The person lacks capacity to make a decision for themselves.
    • There are disagreements about treatment and care between the person, doctors, carers and/or members of the healthcare team.
Basis for recommendation
  • This information is based on guidance from the National Institute for Health and Clinical Excellence [NICE, 2004] which incorporated information from the Gold Standards Framework, a nationwide programme aimed at optimizing palliative care at home [Thomas, 2003].
  • The information on issues of refusing treatments, assessing capacity, and disagreements regarding treatment and care, are based on the General Medical Council's guidance for doctors, Treatment and care towards the end of life: good practice in decision making [GMC, 2010].

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