Recognising that a patient is dying

The Australian Commission on Safety and Quality in Health Care defines dying as 'the terminal phase of life, where death is imminent and likely to occur within hours or days, or occasionally weeks'. Other terms used to describe this stage include ‘terminal phase’ or ‘actively dying’.

This is a period of increasing care needs and recognition that a patient is dying and skill at communicating this with the person and families is important. The Supportive and Palliative Care Indicators Tool (SPICT) is a validated tool that you can use to assess deterioration for a range of advanced serious conditions. If you answer 'yes' to any of the questions this indicates that it is time to assess the person’s holistic needs and start planning future care with them.

SPICT4ALL (307kb pdf)

The End of Life Symptoms pages in the GP section in CareSearch provide guidance on care at the end. The Symptoms and Medicines pages in palliAGED outline specific guidance based on best practice management of medications and symptoms in the terminal stages.

There are also guidelines and pathways available to guide care point of care decision making at this stage:

A word about EOL Care Pathways

Care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. The Liverpool Care Pathway for the Dying Patient (LCP) is the most widely recognised and acknowledged integrated care pathway, and has been utilised and modified across the world.

In 2013 stories in the press and broadcast media concerning the LCP in the UK were highlighting where care had not been optimal and rather than initiate conversations with families and with each other, staff had taken a tick box approach. A review was subsequently undertaken, led by Baroness Julia Neuberger (chair) with over 40 recommendations for change.

However, LCP was also adapted and implemented in 20 countries often with assistance from the Liverpool team. [1] This was frequently based on a ‘plan’, ‘do’, ‘study’, and ‘act’ approach to encourage monitoring and evaluation, and with an improved outcome compared to the UK. According to the very extensive review of Clark et al some of the most rigorous implementation research into the LCP was conducted by a cluster of nine countries including Australia and Italy. [1] Collectively the experiences in these countries were regarded as successful although effectiveness was not uniformly demonstrated under controlled conditions. Tailored EoLCPs continue to be implemented in a number of countries reportedly without the problems encountered in the UK.

It is worth noting that no pathway is set in stone. None of them should be prescriptive to the exclusion of common sense (and a patients’ changing condition). If this is the case, then inappropriate treatment and care can take place. Pathways, guidelines or frameworks should not take the place of impeccable assessment / re-assessment.

  1. Clark D, Inbadas H, Seymour J. International transfer and translation of an end of life care intervention: the case of the Liverpool Care Pathway for the dying patient. Wellcome Open Res. 2020 Oct 27;5:256. doi: 10.12688/wellcomeopenres.16321.1

Last updated 20 August 2021