Ideally patients’ wishes for the care they receive should be known prior to the dying phase as often time is limited and resources need to be rapidly mobilized. An important part of this is enquiring about where a patient would prefer
to die. In one study, 36% of ESKD patients expressed a desire for a home death yet most of these patients die in hospital. Planning for end of life care at home is difficult as preparing and supporting a patient and family for a home death can be time and resource consuming, and requires a level of coordination and sharing of knowledge and experience that is Rapamycin nmr not always easy to achieve. Thus early knowledge that this is a patient’s wish is essential. Essential components of EOL Pathway The LCP (see example at http://www.liv.ac.uk/mcpcil/) is mainly useful in the acute inpatient setting to assist non-Palliative Care specialist teams to ensure a good death for all their patients. It has some essential components which translate to the end of life setting for any illness. These components make up the model of care (Table 2). Here these are broken down and practical advice on prescribing for end of life in CKD given. As previously mentioned, a Renal
LCP has been developed in the UK. 1. Diagnosing dying Uncertainty is an integral LY2606368 purchase part of dying. Often patients who are expected to die survive much longer than expected, while some people die suddenly, however without the recognition that a patient may be dying, EOL management cannot be put into place. Unfortunately Elongation factor 2 kinase there are several barriers to diagnosing dying and thus to access to good EOL care. Barriers: Hope the patient may improve
Pursuance of futile interventions Disagreement about the patient’s condition Failure to recognize key symptoms and signs Lack of knowledge about how to care for/prescribe for dying patient Poor ability to communicate Concerns about foreshortening life Concerns about withholding treatment Cultural and spiritual barriers Signs which are usually associated with the dying phase in cancer: Patient is bedbound Semi-comatose or unconscious Able to take only sips of fluid No longer able to take oral medication The predictability of the dying phase is not always so clear in other chronic life-limiting illnesses. A recent study however showed the trajectory in conservatively managed ESKD to be similar to that of malignancy, in that the Karnofsky Performance Status is relatively stable with a rapid decline in the 1–2 months prior to death. Theoretically, this means that there will be an indication for most patients that death is approaching, and the above criteria can be applied to these patients.