priorities for care

Priorities for care

Priorities for care of the dying person

The five priorities for care of the dying person are the supporting principles when caring for an individual thought to be in the last few days and hours of life. This approach focuses on giving individualised, compassionate care.

Every member of staff has a responsibility to know and understand the priorities even if they don’t regularly come into contact with patients at the end of life.

1. Recognise

  • If a person unexpectedly deteriorates consider if there is a potentially reversible cause. A doctor must assess if change is potentially reversible or if person is likely to die within a few hours or days
  • If potentially reversible, take prompt action in accordance with person’s wishes (or best interests, if lack mental capacity)
  • If likely to die very soon, communicate this clearly and sensitively to the person (if conscious and have not indicated they would not wish to know) and family and those important to the person. If the person has capacity, discuss current preferences
  • Take into account the person’s views and preferences, and develop and document plan of care 
  • Regularly review person to make sure plan of care remains appropriate and respond to change in condition, needs and preferences.

2. Communicate

  • Remember that open, honest and sensitive communication is critically important
  • Use clear, understandable and plain language – verbally and in all other forms of communication
  • If needed, provide additional support to help dying person and their family understand information, communicate their wishes or make decisions
  • Remember that communication is two-way. Listen to views of person and those important to them, not simply provide information. Any differences of opinion should be openly discussed and addressed
  • Communication must be sensitive and respectful in tone and pace. Take in to account what the dying person, and those that are important to them want and feel able to discuss at this time and in the future
  • Check the other person’s understanding of information that is being communicated, and document this.

3. Involve

  • Involve the dying person, to the extent they wish to be, in day to day decisions about food, drink and personal care and in clinical and treatment decisions
  • Find out, and respect, the extent to which individuals wish their families and those important to them to be involved in decision making
  • Tell the person, and those important to them, who is the senior doctor who has responsibility for their treatment and care, and who is the nurse leading their care
  • Check whether there is an advance care plan in place
  • Where it is established that the dying person lacks capacity to make a particular decision, that decision or action taken on their behalf must be in their best interests. Involve them as far as possible.Consult an independent mental capacity advocate (IMCA) if the person lacks capacity and has no family, friends or carer.

4. Support

  • Remember that families and those important to the dying person, including carers, have their own needs which can be unintentionally overlooked at this time
  • Recognise that they may be physically and emotionally tired, anxious or fearful
  • Ask about their needs for support or information, and meet these as far as possible
  • Listen to, and acknowledge their needs and wishes, even when it is not possible to meet all of them
  • Where a dying person lacks capacity, explain the decision-making process to those people who are supporting the dying person and involve them as much as possible.

5. Plan & do

  • Develop an individualised plan of care and treatment to meet the dying person’s own needs and wishes, and document this so that consistent information is shared with those involved in the person’s care and is available when needed
  • Pay attention to symptom control. Consider the 5 key symptoms of pain, breathlessness, agitation, respiratory secretions and nausea and vomiting
  • Pay attention to the person’s physical, emotional, psychological, social, spiritual, cultural and religious needs
  • Support the person to eat and drink as long as they wish to do so and are able to do so safely
  • Refer to specialist palliative care if the person and/or situation require this and ring for advice if unsure about anything.

Advance care plan

Planning for your future care (advance care planning) gives you the opportunity to think about, talk about and write down your wishes, preferences and priorities for your care. This includes how you would like to be cared for towards the end of your life. You can include anything that is important to you, no matter how insignificant it may appear. 

Advance care planning can help you and your carers (family, friends and professionals who are involved in your care) understand what is important to you. The plan helps you to discuss your views with those who are close to you. It will help you to be clear about the decisions you make and keep a written record of your wishes so that they can be carried out at the appropriate time. Recording your wishes and preferences for care helps to make sure that your wishes and preferences are taken into account. You can choose who you share this information with.

An advance care plan can be created at any time. It is a good way to make sure your wishes are recorded and allows a secure approach on life.

To help you with your planning we have created an 'Advance care plan' that you can fill in, dowload a copy here:  Advance Care Planning (ACP) booklet Version Three[pdf] 2MB or request a copy by contacting the PALS team on acp@nhft.nhs.uk or 0800 9178504.