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Palliative cancer care - general issues - Management
What adjustments to care should be considered in the terminal phase?
- The terminal phase requires a careful discussion with the person, family, and carers regarding the following issues. This may involve discussing and weighing up the benefits, burdens and risks for the person:
- Stopping any unnecessary drug treatments and continuing other drug treatments by an appropriate route.
- Having commonly required medication available in the house (e.g. cyclizine, diamorphine, hyoscine hydrobromide, and midazolam), so that new or developing symptoms can be treated without delay.
- Control of physical symptoms.
- Realistic goals (e.g. in terms of treatment and resuscitation issues).
- Religious and spiritual care.
- Providing an appropriate environment (e.g. one which is comfortable and has an appropriate level of noise and activity for the person).
- If the person is likely to require care out of normal surgery hours, ensure that the local on-call service has been informed and given an effective handover.
- Provide emergency contact numbers and information on what to do when death occurs.
Clarification / Additional information
- The Liverpool Care Pathway for the Dying Patient provides a national framework caring for people in the terminal phase. It integrates professional communication and documentation, putting national guidelines into clinical practice. For more information, see www.mcpcil.org.uk/liverpool-care-pathway.
Basis for recommendation
- These recommendations are based on guidance from the National Institute for Health and Clinical Excellence [NICE, 2004], expert opinion from palliative care resources [Twycross and Wilcock, 2001; Regnard and Hockley, 2004], and the General Medical Council guidance for doctors, Treatment and care towards the end of life: good practice in decision making [GMC, 2010].
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