END OF LIFE CARE

End of Life Care

End of Life Care

The word 'end of life' has its origins in the Latin word 'pallium' meaning to cloak or cover. In the context of how cancer was perceived and poorly diagnosed from the middle ages until perhaps the latter half of the 20th century, it is an appropriate description. Even today, there are many cancers that grow unseen and without symptoms for a considerable time before the person seeks help. A more contemporary and simple definition is 'to mitigate the sufferings of the patient, not to effect a cure'(Macpherson, 2002).

Take the example of the common cold, for which there is no cure. The experience is uncomfortable, but thankfully not usually life-threatening. The only relief obtainable is direct palliation of the most prominent symptoms, in the recognition that cure is not an option but with the intention to improve quality of daily life. As an experience, it is one to which we can all relate and, in the context of end-of-life care, the meaning is abundantly clear.

In the past decade, there has been an increasing focus on patient choice and self-determination within health and social care settings. In the UK, many initiatives (NICE, 2004; Department of Health, 2003; Commission for Health Improvement and Audit Commission, 2001) have highlighted specifically that patient choice over place of death should be considered a priority.

The End-of-Life Care Programme was set up in England in 2005 (NHS Confederation, 2005) to promote three initiatives independently developed to facilitate good practice for dying patients: the Gold Standards Framework (Thomas, 2003); the Liverpool Care Pathway (Ellershaw et al, 2003); and the Preferred Place of Care document (Storey et al, 2003). Now, some three years after its implementation, the government's End of Life Care strategy (Department of Health, 2008) offers an ongoing evaluation of these three initiatives and their impact on direct care.

Nurses in any environment where people die are beginning to encounter these initiatives, which centre around planning and prioritising care for people in the weeks and months leading up to their deaths.

The Gold Standards Framework is designed to be used by district nurses and GPs. The Liverpool Care Pathway is designed to be used by all disciplines within acute care, long-stay settings and nursing home environments, where it helps prioritise care in the last week or so of life. Preferred Place of Care, the only nurse-led initiative, is designed to be ...