Clinical Guidance And Resources
Palliative Care Clinical Guidance – known locally as the ‘Green Book’ – is written by the Wessex Palliative Physicians. It is a consensus of good practice for the management of all sorts of symptoms, breaking bad news, psychological and spiritual support for people with advanced disease and their families. Green Books are available free of charge from Forest Holme Hospice, funded by Forest Holme Hospice Charity, or can be downloaded here The Palliative Care Handbook 9th Edition.
Planning ahead for end of life care
Identifying people who are approaching the end of life can be difficult but the following indicators can help:
- The Surprise Question: would you be surprised if this person were to die in the next few months, weeks or days?
- Recurrent, unplanned admission to hospital
- Limited reversibility in the underlying condition
- Deterioration over recent months
As the end of life approaches it can be useful to ask:
- What is the person’s understanding of their condition?
- What is their expectation in terms of prognosis?
- What are they hoping for?
- What do they fear?
- What is important to them? What matters most to them?
Opening up discussions like this can help people to identify their priorities and start to plan ahead. The discussion doesn’t have to take place all in one go.
If patients start to identify their priorities it is important that others are aware of this – this will help to ensure their care is appropriate and in accordance with their wishes.
Preferences can be documented in EPR or the Dorset Care Plan. The Dorset wide Planning your future care – Advance Care Planning is available to download for individuals to complete themselves.