End-of-life Care

Keyword: palliative care, end of life, end

Policy

For more information about providing quality end-of-life care, see Te Ara Whakapiri: Principles and guidance for the last days of life.

We understand the importance of supporting patients, their families/whānau, and the community, when a patient has a life-limiting illness.

We work to provide well-coordinated palliative, and end-of-life care services that support the patient humanely, and with dignity. We use an integrated approach to palliative and end-of-life care, working closely with other providers and support services as needed.

Because each case is shaped by the the individual, their family/whānau, and the unique circumstances, end-of-life care is handled on a case-by-case basis and is regularly reviewed as the patient's situation evolves.

Care is provided wherever the patient is – in their home, a hospital, community clinic, or hospice.

Providing end-of-life care

As the lead care coordinator, the primary GP:

• provides the patient and their family/whānau with information that tells them who to contact after hours, and how to contact them
• ensures an informed deputy is available, if necessary
• arranges any community support needed
• liaises with other health professionals involved in the patient's care
• may make a referral for palliative care or to the Hospice Team
• considers whether to use the Te Ara Whakapiri plan for care in the last days of life.

If needed, the primary GP seeks guidance from specialist palliative care agencies to support the patient and manage their symptoms.

See HealthPathways for more information about accessing palliative care services.

Care after hours

Q90

Patients are able to contact their lead care coordinator or an informed deputy at all times.

End-of-life patients/whānau are given the on-call phone number to connect directly with the on-call clinician after-hours.

If the primary GP will be unavailable for a period of time, they advise the patient that their health information will be disclosed to other GPs at the practice, if needed.

The primary GP records details about the patient's situation in their medical records. The GP meets regularly with the district nurses to discuss the management of palliative patients.

Patient choice

We support patients in making informed choices about their health care, and help them to receive care that aligns with their culture and values. End-of-life considerations can set in motion conversations about shared care, advance care planning, and Enduring Power of Attorney. The primary GP may also:

• discuss care choices, including whether shared care or an advance care plan would be beneficial.
• suggest options for managing future wishes, e.g. setting up an Enduring Power of Attorney.

Discussions and decisions about the patient's care are communicated and documented clearly, but with sensitivity.

Refer to Cole's Medical Practice in New Zealand: Chapter 3 – End-of-life issues and bpacnz: Navigating the last days of life: a general practice perspective

Equity

We make every effort to ensure that all interactions concerning end-of-life matters are centred around the patient and their family/whānau, and are culturally appropriate. We are guided by the Te Whare Tapa Whā model when supporting our patients.

Tō tātou reo | Advance care planning website has information for clinicians.

End of life, palliative