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- Identifying end of life patients
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- How to help your patients plan
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- Useful resources
- Case studies
Dr Peter Nightingale: my experience
The following case study is based on a real case report. It was written by Dr Peter Nightingale, pictured, a practising GP in Lancaster with a special interest in diabetes.
Ron Smith (not his real name) was a well known patient to me. He was an 82-year-old retired teacher with diabetes, peripheral neuropathy and ischaemic heart disease. He developed heart failure and was admitted to hospital after a convulsion caused by hyponatraemia.
He saw me four months ago requesting no further hospital admissions and he expressed a desire not to be resuscitated. We discussed future planning in the surgery and he agreed to look at advance care planning documentation. He was content to complete a preferred priorities of care (PPC) document and a Do Not Attempt Resuscitatation (DNAR) form.
He took these documents away, discussed them with his family and brought them back to me a week later. I notified the out of hours GPs using a web-based information sharing system, as well as the local ambulance service and all my partners. We added him to our practice’s Gold Standards Framework palliative care register.
A dignified death
Four months later, Ron started to decline. He was offered acute admission but he requested to stay at home. One morning, having eaten breakfast with his wife, Ron suddenly collapsed, as is common in chronic heart failure. He died in his home and the last words he heard were those of his loving wife.
Without advance care planning, Ron could so easily have had a hospital death, with a futile and undignified attempt at resuscitation. After Ron's death I sat with his wife in the lounge. Ron's PPC was on the coffee table. We flicked through it and realised that Ron had achieved the death he had wished for those many months before. This was of great comfort to his wife and a professionally satisfying moment for me. Without advanced care planning, the bereavement experience of this family would have been very different.
Case study: Professor Mayur Lakhani
"Creating a plan of care transformed the situation" - View Professor Mayur lakhani's case study
Case study: Dr Catherine Millington-Sanders
"Working with a deteriorating elderly patient to ensure he had the death he wanted" - View Dr Catherine Millington-Sanders' case study