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End of life care: Making sound clinical judgements

24. The starting point for reaching good decisions is careful consideration of the patient’s clinical situation, whether providing care in a community or a hospital setting. You must carry out a thorough assessment of the patient’s condition and consider the likely prognosis. It can be difficult to estimate when a patient is approaching the end of life, and you should allow for a range of possibilities when planning care.

25. You should identify treatment options based on:

(a) up-to-date clinical evidence about effectiveness, side effects and other risks

(b) relevant clinical guidelines on the treatment and management of the patient’s condition, or of patients with similar underlying risk factors, such as those issued by the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN).

26. You must also give early consideration to the patient’s palliative care needs, and take steps to manage any pain, breathlessness, agitation or other distressing physical or psychological symptoms that they may be experiencing, as well as keeping their nutrition and hydration status under review.

27. You must seek advice19 or a second opinion20 from a colleague with relevant experience (who may be from another specialty, such as palliative care, or another discipline, such as nursing) if:

(a) you and the healthcare team have limited experience of the condition

(b) you are uncertain about how to manage a patient’s symptoms effectively

(c) you are in doubt about the range of options, or the benefits, burdens and risks of a particular option for the individual patient

(d) there is a serious difference of opinion between you and the patient, within the healthcare team, or between the team and those close to a patient who lacks capacity, about the preferred option for a patient’s treatment and care

(e) it is decided that clinically assisted nutrition or hydration should be withdrawn or not started in the circumstances set out in paragraphs 119-120.