David Oxenham: End-of-life care needs thought

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The care that we receive in the final weeks or months of our lives is a highly emotive and important subject. Most of us will have a preference for where we would like to die and how we would like to be cared for, but how sure can we be that those preferences will be adhered to?

The recommendations outlined in the Scottish Government’s national action plan Living and Dying Well, which aims to ensure that end-of-life care needs are recognised in all care settings, have begun to enable more patients to have the opportunity to think through these important issues so that their wishes can be respected.

However, this continues to be challenging, particularly for people with illnesses where it is more difficult for patients, professionals and families to recognise and agree that the last few weeks or days are imminent.

That’s why we are taking the lessons and experience we have gained from patients with cancer to understand what this means for people dying from other diseases.

We know that Marie Curie’s Nursing Service improves care for terminally ill people and their families.

The evidence shows that the people we care for are more likely to die at home and less likely to have an emergency admission to hospital.

By keeping people out of hospital, we can not only help them to achieve as comfortable a death as possible, but we can also help to reduce costs to the NHS.

We should therefore be supporting patients and their families to make choices about what they want and ensuring that the best possible quality of care is available outside the hospital setting.

We also know that the provision of good quality end-of-life care varies greatly and that people often struggle to make decisions about their own care.

That’s why we are working closely with policy makers and health professionals in Scotland, and across the UK, to ensure that they understand the real need and provision for people who are nearing the end of their lives.

• Dr David Oxenham is clinical director of Marie Curie Cancer Care.

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