Synopsis
Recognise changing needs, relieve symptoms, support informed preferences and carers, coordinate round-the-clock community care and respond safely to deterioration without reducing end-of-life care to anticipatory prescribing.
- Palliative care can begin alongside disease-modifying treatment; “end of life” must not be used as a reason to stop active symptom assessment.
- Recognise possible deterioration from trajectory, function, intake, consciousness and escalating care needs, and explain uncertainty honestly.
- Ask what matters, where the person wishes to be cared for, who should be involved and what trade-offs are acceptable; preferences can change.
Key red flags
Severe pain, breathlessness, bleeding, seizures or agitation needs rapid assessment and treatment through the agreed urgent pathway.
Reasoning priorities
Identify symptom mechanism, reversible causes and whether dying is likely.
Investigate only when results could change care consistent with goals; do not assume all change is irreversible.
Worked reasoning
A person with advanced cancer, assessed as entering the last days of life, becomes breathless at home; oxygen saturation is 95%, anticipatory medicines are present, and the family is unsure what to do.
- Assess remotely only as far as safe and arrange urgent in-person review based on distress: clarify onset, chest pain, bleeding, fever, breathing effort, consciousness, goals and the existing escalation plan; call emergency services for immediate threat.
- At assessment, reason through reversible contributors and symptom burden; recognise that normal-range saturation provides no indication for routine oxygen and confirm what prescribed medicine, route and administration authority actually exist.
- Take the final action: use positioning, airflow and reassurance, treat a reversible cause when aligned with goals, and have the authorised trained clinician give individually prescribed symptom medicine or seek specialist advice rather than asking family to improvise.
- Verify relief within a defined interval, ensure 24-hour contacts and records are accessible, check medicine supply and caregiver ability, and escalate to specialist palliative care, hospice or hospital if symptoms remain uncontrolled or home care is unsafe.