End of life care: how do we move forward?


Death and dying are inevitable. High quality and accessible palliative and end of life care can help people who are facing progressive life-threatening and life-limiting illness, and those dear to them, by focusing on their quality of life and addressing the problems associated with their situation. This paper draws attention to the scale of the challenge, some of the key areas we could address and the shifts in culture, mindset and leadership approach that are needed.

The challenges of renal replacement therapy and renal palliative care in the elderly

The main aim of this review is to let general practitioners and physicians understand what happens to older patients after referral to the renal service. Usually, most patients will be managed completely by the renal team, either because the patient requires dialysis or because conservative but specialised care is appropriate. The recent increase in dialysis rate can mostly be accounted for by older patients for whom such demanding treatment was previously thought to be contraindicated.

Palliative care for patients with advanced chronic kidney disease

Over the past three decades there has been a dramatic rise in the number of patients with advanced chronic kidney disease. The fastest expanding group receiving dialysis has been the elderly. However, for those patients who are very elderly with co-morbidity, dialysis may not offer a survival advantage. Therefore, active conservative management is a growing service offered by many renal units in the UK and focuses on non-dialytic correction of fluid and electrolyes, management of renal anaemia, and assessment and management of symptoms.

Improving the care of patients with advanced heart failure

A strategy for managing heart failure based exclusively on conventional treatment results in the majority of patients having inadequate symptom control, a poor quality of life and uncoordinated care. The Scottish Partnership for Palliative Care report Living and dying with advanced heart failure: a palliative care approach advocates that these problems should be addressed by the integration of conventional and supportive care; at present this rarely happens.

Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants

Objective: To establish whether Foundation Year 1 (FY1) doctors in Edinburgh are sufficiently  prepared to deliver generalist palliative care, with a view to informing developments in  undergraduate and postgraduate medical education.

Methods: Questionnaires were sent to FY1 doctors and to supervising consultants. Semi-structured interviews were conducted with five FY1 doctors.