Question: Who’s the expert here?
Answer: The patient is the expert about what’s important to them.
Authentic engagement with the patient requires:
- compassion, knowledge, experience, sensitivity and skill
- responsiveness to sexual, cultural and linguistic diversity
- one, two or a series of conversations to elicit the patient’s goals, values and wishes
- inclusion of substitute decision-makers, families and carers, according to the patient’s wishes
- education, training and exposure to good practice.
Events indicating the need for a conversation about care in the last 12 months of life include:
- a life-limiting illness is diagnosed
- a patient who is likely to die in the short to medium term is admitted, or deteriorates during the admission
- a patient living with a life-limiting illness has recurrent, unplanned or recent admissions
- a previously well person who has suffered an acute life-threatening event or illness is admitted
- unexpected, significant physical deterioration occurs
- the patient decides to withdraw life-prolonging interventions1
- any patient (or medical treatment decision maker, carer or family member, if the patient lacks capacity) expresses interest in discussing end of life care, no matter how vague the interest might seem
- death is imminent.
See Therapeutic Guidelines Palliative Care 2016 Version 4 on the Clinicians Health Channel at your health service
1For example, renal dialysis, total parenteral nutrition or non-invasive ventilation