Palliative & End-of-Life Care · Full case

Palliative & End-of-Life Care

NICE NG31NG142NG184
PC
Palliative Care · Clinical Reasoning Framework v2
GP & SCA · NICE NG31 · NG142 · NG184 · GSF · RESPECT · DNACPR · Syringe Driver · Anticipatory Medications · Opioid Conversion
Oral morphine ÷ 3 = SC diamorphineOpioid conversion for syringe driver: oral morphine 30mg/24h → subcutaneous diamorphine 10mg/24h (divide by 3). Oral oxycodone ÷ 1.5 = SC oxycodone. Oral morphine ÷ 2 = oral oxycodone. Oral hydromorphone × 5 = IV hydromorphone. Always confirm with local formulary and palliative care team. Convert the total daily oral dose, then load the syringe driver over 24 hours. PRN breakthrough dose = one-sixth of the 24-hour syringe driver dose.
Surprise Question = GSF register trigger“Would you be surprised if this patient died in the next 12 months?” Answer No = patient should be on the Gold Standards Framework (GSF) Palliative Care Register (locally known as the palliative register or anticipatory care register). GSF triggers also include: two or more emergency hospital admissions in the past 6 months; Karnofsky score <50%; prognostic indicator (SPICT; Gold Standards Framework criteria). Annual register review mandatory. QOF indicator for palliative care registers in UK general practice.
DNACPR ≠ Do Not TreatDNACPR (Do Not Attempt Cardiopulmonary Resuscitation) applies only to CPR — it does not affect any other treatment: antibiotics, IV fluids, analgesia, oxygen, hospital admission, or any other medical care continue unless separately discussed and agreed. GPs who fail to explain this distinction to families create profound distress and the risk of appropriate treatment being withheld. DNACPR is a clinical decision that requires communication — not just documentation. RESPECT form (ReSPECT = Recommended Summary Plan for Emergency Care and Treatment) is the current standard in England, Wales and Scotland — a broader conversation about the patient’s values, goals and preferences.
4 anticipatory medications: SAASAnticipatory (just-in-case) medications for the last days of life — the four domains: (S) Subcutaneous opioid for pain (morphine or diamorphine PRN); (A) Anxiolytic / sedative for agitation and breathlessness (midazolam); (A) Anti-emetic for nausea and vomiting (cyclizine or levomepromazine); (S) Antisecretory for terminal secretions (hyoscine hydrobromide or glycopyrronium). These are prescribed in anticipation so that community nurses can administer them at the point of need without waiting for an urgent GP call.
Opioid naïve: morphine 2.5mg 4-hrly + PRNIn an opioid-naïve patient: start with oral morphine 2.5mg every 4 hours (regular) PLUS morphine 2.5mg PRN every hour for breakthrough pain. Review after 24–48 hours: count the number of PRN doses taken; add this to the regular dose to calculate the new 24-hour total; divide into four-hourly doses (or convert to modified-release morphine in a stable patient). Always check renal function: morphine accumulates in renal impairment — use oxycodone or hydromorphone if eGFR <30. Never use diamorphine as a starting opioid in a new patient — titrate with oral morphine first.
Preferred place of death: ask, record, reviewMost people state a preference to die at home; most currently die in hospital. The Dying Well Community Charter and NHS Long Term Plan (2019) target increased proportion of home deaths and hospice deaths. Key GP actions: ask the preferred place of death at GSF register entry; record in the patient’s care plan and on the electronic record (SCR/Summary Care Record); inform out-of-hours GP; ensure anticipatory medications are prescribed and accessible at home; coordinate with district nursing and community palliative care teams. Preferred place of death should be reviewed regularly as preferences change.
Mental Capacity Act: 5 principlesMCA 2005 governs all decisions about care and treatment in England and Wales. Five principles: (1) Presumed capable unless proven otherwise; (2) Supported to make decisions before concluding incapacity; (3) Unwise decisions are not incapacity; (4) Best interests must guide decision-making when incapacity confirmed; (5) Least restrictive intervention. Capacity is decision-specific and time-specific. Advance Decisions to Refuse Treatment (ADRT / Living Will) are legally binding for the specific treatments refused. Lasting Power of Attorney (LPA) for Health and Welfare must be registered to be valid and activated only after the person loses capacity.
Spiritual needs: ask at every reviewSpiritual and religious needs are a core component of palliative care (NICE NG31): address at every GSF register review; do not assume religious/spiritual preferences from cultural or ethnic background; ask open questions: “Is faith or spirituality important to you at this time?”; “Are there any practices or rituals that would be important to you?”; “Is there anything about your faith or cultural background I need to understand to support you and your family?” Refer to hospital or community chaplaincy where indicated. Cultural needs around death and dying vary significantly: do not impose assumptions.
📋 Clinical Stem — Palliative Care
A 74-year-old woman with metastatic pancreatic cancer, declining ECOG status, pain inadequately controlled on oral opioids, new vomiting, asking to die at home, whose husband is exhausted and whose DNACPR status has not yet been discussed
Mrs. Amrita Patel, 74, was diagnosed with pancreatic adenocarcinoma 7 months ago. She completed one cycle of gemcitabine but the oncology team have advised her that further chemotherapy would be unlikely to benefit her and have referred her back to the GP for palliative and supportive care. She currently takes oral morphine 20mg every 4 hours regularly plus 20mg PRN for breakthrough pain. Over the last 4 days she has developed increasing nausea and vomiting and has been unable to keep her oral morphine tablets down. Her pain has been worsening. She is now mainly bedbound (ECOG 3). Her husband Dhruv, 76, has been her sole carer. He is exhausted and confused about what is happening. Mrs. Patel has told you she wants to die at home. She has a daughter in Birmingham who is flying in next week. There is no DNACPR in place and no advance care plan has been documented. Her renal function (from 3 weeks ago): eGFR 28 mL/min/1.73m² — significant renal impairment.
This stem tests seven core palliative care competencies: recognising that oral medication can no longer be absorbed reliably and initiating syringe driver referral; safe opioid conversion using dose arithmetic; awareness of renal impairment as a contraindication to morphine accumulation (use oxycodone or hydromorphone instead); prescribing the four anticipatory medications; initiating a DNACPR and RESPECT form conversation compassionately; exploring preferred place of death and identifying barriers to achieving it; and supporting the exhausted carer (Dhruv) as a patient in his own right.
Scenario A — Syringe driver initiation Patient with terminal cancer now unable to take oral medications due to vomiting. Task: calculate safe subcutaneous dose equivalent; prescribe for syringe driver (24-hour dose); prescribe four anticipatory medications; arrange community nurse review; brief patient and carer on what the driver does; confirm preferred place of death. Renal impairment (eGFR <30): use oxycodone or hydromorphone, NOT morphine in syringe driver. Diamorphine: preferred where available (very soluble; mixes well with other medications). Community nurse sets up driver; GP prescribes medications; district nursing team reviews every 4 hours.
Scenario B — DNACPR / RESPECT conversation Patient with terminal diagnosis and deteriorating condition; no DNACPR in place; family not present; patient wants to know “what happens if my heart stops.” Task: establish what the patient already knows and understands; explain that CPR would be unlikely to be effective and potentially harmful; explore their wishes; complete RESPECT form documenting values and goals; explain what DNACPR does and does NOT mean (all other care continues); share with out-of-hours GP, ambulance service, and family (with consent). Key: never ask “do you want CPR?” — frame as a clinical recommendation based on what is most likely to achieve their goals.
Scenario C — Pain crisis at home Urgent home visit: patient with known cancer, 8/10 pain despite regular oral morphine. Assess: is the route of administration adequate? (vomiting? constipation? opioid breakthrough needed?). Immediate: subcutaneous morphine PRN from anticipatory medications if prescribed. If not already prescribed: write in-house anticipatory medication prescription today; contact district nursing team; consider urgent palliative care consultant phone advice. Titrate: count last 24-hour PRN usage; calculate new 24-hour total; adjust regular and PRN doses; review in 24 hours. If severe crisis with inadequate medications: admit to hospice or hospital for acute symptom control.
Scenario D — Carer wellbeing and exhaustion Dhruv, 76 (spouse), attends separately or during home visit looking exhausted, distressed, and confused about his wife’s prognosis. Task: assess Dhruv as a patient in his own right (carers have 4× higher risk of depression; are entitled to their own GP care and carer assessment); discuss respite options (Admiral nurse; day hospice; night sitting service; residential respite); check Dhruv’s own health (has he had an annual review? Is he sleeping?); provide information about what to expect in the dying process; address “what do I do when she dies?”; carer’s assessment referral (Social Services); Carers UK; GP annual review for registered carers.
Scenario E — Advance Care Planning (ACP) Patient with declining illness, good cognitive function, wanting to plan ahead. Task: explore values, goals and priorities (what matters most?); explore preferred place of death (home / hospice / hospital) and identify barriers; explain Advance Decision to Refuse Treatment (ADRT): legally binding refusal of specific named treatments; explain Lasting Power of Attorney (LPA) for Health and Welfare: appoints a named person to make decisions when the patient lacks capacity; document all discussions in the patient’s care plan; share with relevant teams (district nursing; out-of-hours; hospice). Advance care planning is a process, not a single event — review at every deterioration.
Key variables to adapt for Diagnosis and trajectory (cancer vs organ failure vs frailty — different prognostic uncertainty); opioid requirement and renal function (eGFR <30 = avoid morphine accumulation; use oxycodone or hydromorphone); preferred place of death and barriers (family capacity; community nursing provision; carer willingness); cultural and religious needs (death rituals; privacy; gendered care preferences; post-death requirements for timing of body preparation); Mental Capacity Act status (is the patient capacitous? Is there a valid ADRT or LPA in place?); family dynamics (absent family; family disagreement about care; children of dying parents; young children in household); stage of prognostic discussion (has the patient been told they are dying?)
Steps:
1
Step 1
History Taking — Open Question First · Symptom Burden · Preferred Place of Death · Carer Assessment · ICE · ACP
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Palliative care consultations are not just symptom reviews — they are conversations about what the patient values, fears, and hopes for in the time remaining. Mrs. Patel cannot take her oral medication because of vomiting: the immediate clinical task is to find an alternative route. But the more important task is to understand what dying at home means to her and Dhruv, what barriers exist, and what support must be put in place to make it possible. Symptom management without preferences exploration is incomplete palliative care.
🎓 SCA opener — acknowledge the journey before asking about symptoms
"Mrs. Patel, thank you for coming in — and I know that coming here takes real effort right now. I have read Dr. Mehta’s letter about what they have told you. I want to start by asking: how are you feeling about where things are at the moment — not just physically, but in yourself?"
In SCA: opening with an open question about emotional experience before symptom review signals that this is a whole-person consultation. It scores Relating to Others and Global Skills. Candidates who open immediately with “tell me about your pain” miss the deeper ICE layer and are likely to miss the DNACPR and preferred place of death conversations entirely.
1A — Open question, then symptom history
QuestionWhy it mattersChanges what?
🏲 OPEN QUESTION"How have things been since you last came? How are you feeling in yourself — physically, and how are you finding it emotionally?"The open question in a palliative consultation has a different function from a diagnostic one: it is not primarily seeking the symptom list — it is giving the patient permission to say what is most on her mind. Mrs. Patel may lead with her pain; she may lead with her concern about Dhruv; she may say “I want to know how long I have.” What she leads with reveals what matters most to her, which determines the priority of the consultation. In SCA: this scores Global Skills (data gathering); Relating to Others (empathy); and frequently leads directly to the Tasks (if she leads with preferred place of death or DNACPR, the candidate has been given the territory).Resist the urge to immediately start a symptom checklist. Give Mrs. Patel space to speak.What patient leads with = what matters most = consultation agendaEmotional state may reveal unspoken fears about dying or carers
Pain — comprehensive assessment"Can you tell me about your pain — where is it, what does it feel like, how bad is it on a scale of 0 to 10, what makes it better or worse, and how is your current pain relief working for you?"The WHO analgesic ladder and NICE NG142 framework for opioid titration require a thorough pain assessment. For Mrs. Patel: site (pancreatic pain is often epigastric and radiates to the back; bone metastases cause different pain; neuropathic pain responds differently); character (constant dull aching = opioid-responsive; burning/shooting = neuropathic; breakthrough sharp = incident pain); severity (NRS 0–10); current opioid dose (morphine 20mg 4-hrly = 120mg/24h oral morphine; significant dose). Critically: she has been vomiting for 4 days and cannot absorb her oral tablets. She needs an alternative route urgently. The morphine she is taking is not reaching its target.Inability to absorb oral opioid = syringe driver indication; convert dose to SC equivalentRenal function: eGFR 28 = morphine accumulation risk; switch to oxycodone
Nausea, vomiting, swallowing"How long have you been vomiting? Can you keep any fluids down? Have you taken your morphine tablets today? Are any medications staying down at all?"Vomiting for 4 days in a patient on oral opioids represents an urgent symptom management failure: she is receiving no effective analgesia. The causes of vomiting in advanced cancer are multiple: opioid-induced (common; often coincides with starting or increasing opioids); bowel obstruction (partial or complete; examine for colic, abdominal distension); hypercalcaemia; raised intracranial pressure; gastric outlet obstruction; hepatic capsule pain with diaphragmatic splinting. Identifying the cause determines the antiemetic choice and whether IV fluids or surgical intervention are relevant. The practical question: can she take anything by mouth at all? If not: syringe driver today, not next week.Antiemetic choice: cyclizine (vestibular/opioid); metoclopramide (gastroparesis); levomepromazine (broad-spectrum); ondansetron (not routine)Complete bowel obstruction = surgical opinion; colic + distension + no flatus ⇒ may need urgent assessment
Preferred place of death"You mentioned before that you wanted to die at home. Is that still what you want? And what would need to be in place to make that possible — what are your worries about it?"Preferred place of death (PPD) must be: (1) asked — patients rarely volunteer this; (2) recorded — in care plan, SCR, out-of-hours alert; (3) actioned — anticipatory medications, community nursing, family briefing, OOH alert. For Mrs. Patel: she wants to die at home. The barriers: Dhruv is 76 and exhausted (carer capacity); daughter is not arriving until next week; she may need community nursing 2–3 visits/day; she needs anticipatory medications prescribed and accessible at home; she needs night sitting provision. If any of these cannot be guaranteed: hospice is the alternative — framed as enabling her to receive the care she deserves, not as abandonment of her wish.PPD = home ⇒ anticipatory medications; community nursing; night sitting; OOH alert; carer supportPPD = hospice ⇒ refer to local hospice for assessment; consider day hospice first if not imminently dying
Prognosis awareness and information needs"Do you have a sense of how things are going with your illness? Is there anything you have been wanting to ask me that you haven’t yet?"Understanding what Mrs. Patel knows about her prognosis is essential before any management decisions. Has she been told she is dying? Has she been given a timeframe? Does she want to know more, or less? The oncology letter said “no further chemotherapy” but this may not have been translated into “I am in the last weeks to months of my life” in her understanding. The GP who assumes the patient knows their prognosis — and proceeds to discuss DNACPR without checking — may cause profound distress. The question “is there anything you have been wanting to ask that you haven’t yet?” is one of the most powerful questions in palliative care and often prompts the most important disclosures.Prognosis awareness: shapes DNACPR conversation; ACP; family briefing; spiritual preparationPrognostic uncertainty: SPICT criteria; GSF trigger criteria; “Surprise Question” = No ⇒ palliative register
1B — Red flags: acute palliative emergencies
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Palliative Emergencies — act before completing the history

EmergencyWhy dangerousAction
Spinal cord compression — back pain + new leg weakness / numbness / urinary retentionMalignant spinal cord compression (MSCC): oncological emergency; occurs in 5–10% of cancer patients; vertebral metastasis compresses the spinal cord or cauda equina. Window of opportunity: if decompressed before irreversible paraplegia, function can be recovered. Indicators: new back pain (often worse on lying flat or coughing); leg weakness; sensory level; urinary or bowel retention or incontinence. Any suspicion: dexamethasone 8mg IMMEDIATELY (before imaging); urgent MRI; oncology/neurosurgery same-day referral.Dexamethasone 8mg immediately; same-day MRI; oncology referral; do not wait for imaging before steroids
Superior vena cava obstruction — facial swelling, arm swelling, breathlessness on bending forwardSuperior vena cava obstruction (SVCO) from mediastinal tumour or lymphadenopathy: venous drainage from head and arms obstructed. Features: facial oedema; periorbital oedema (worse in mornings); arm swelling; distended neck veins; Stokes sign (coat collar feeling); breathlessness. Dexamethasone 16mg immediately to reduce peri-tumour oedema; urgent oncology referral (radiotherapy ± stenting).Dexamethasone 16mg immediately; urgent oncology referral; emergency if severe respiratory compromise
Hypercalcaemia — confusion, constipation, polyuria, nausea, vomiting, dehydrationHypercalcaemia of malignancy: corrected calcium >2.6 mmol/L; mediated by PTHrP (parathyroid hormone-related peptide) from tumour. Symptoms: “bones, groans, stones and psychic moans” — confusion; constipation; abdominal pain; nausea; polyuria; polydipsia; dehydration. Fatal if untreated. Treatment: IV fluids (4–6L/24h); IV bisphosphonate (zoledronic acid or pamidronate) — bisphosphonates cannot be given without adequate hydration. Hospital admission for treatment. Often the diagnosis because presentation is non-specific and confused with disease progression.Urgent U&E and corrected calcium; IV fluid resuscitation; IV bisphosphonate (hospital); do NOT give PO bisphosphonates acutely
Acute pain crisis — severe uncontrolled pain despite adequate analgesiaPain crisis in terminal cancer: opioid dose may be inadequate; a new pain generator (pathological fracture; visceral obstruction; nerve infiltration) may require a different approach; inadequate route of administration (vomiting patient on oral opioids). Immediate: subcutaneous morphine or oxycodone PRN from anticipatory medications if available; if not: urgent palliative care phone advice; consider urgent hospice or hospital admission for pain control if severe crisis. Never leave a patient in severe pain at home without a clear plan for medication escalation.SC PRN analgesia from anticipatory medications; if not prescribed: prescribe today; urgent palliative care team phone advice; consider hospice admission for acute pain control
Massive haemorrhage — haemoptysis; haematemesis; rectal bleeding from tumourMajor haemorrhage from tumour erosion of a blood vessel. Can be sudden and catastrophic. For patients at known risk (haemoptysis from lung or head and neck cancer; GI bleeding): advance care planning should address this scenario; family should be briefed; midazolam 10mg SC should be available in anticipatory medications for sedation in catastrophic haemorrhage (not to stop bleeding but to relieve distress). Dark red or green blankets available at home to reduce visual impact. 999 if sudden major haemorrhage and patient not at home (resuscitation may be appropriate depending on goals of care).If conscious and severe: 999. If at risk: brief family; dark blanket; midazolam in anticipatory medications prescribed in advance
Terminal agitation — restlessness, confusion, distress in the last hours to daysTerminal agitation (terminal restlessness): common in the last 24–48 hours of life; causes include urinary retention; constipation; uncontrolled pain; cerebral hypoxia; opioid accumulation; fear; spiritual distress. Assessment first: rule out treatable causes (check catheter; give PRN analgesia). If terminal: midazolam SC PRN (2.5–5mg); or levomepromazine SC PRN (6.25–12.5mg). Via syringe driver if continuous sedation needed. Family preparation: explain this is part of the dying process; it does not necessarily indicate distress if the patient is unconscious; comfort measures are the priority.Rule out treatable causes; SC midazolam or levomepromazine PRN; consider syringe driver; brief family and nursing team; do not leave isolated
🛡️

Safeguarding — Carer Capacity and Vulnerable Adults

Palliative care situations frequently generate safeguarding concerns. Dhruv is 76 and is the sole carer for his dying wife: carer exhaustion can create situations where the patient’s needs are not being met — not through neglect, but through incapacity. Carers of people with terminal illness have 4× higher rates of depression, anxiety, and physical illness than non-carers. Dhruv is also a vulnerable adult whose needs require proactive assessment alongside Mrs. Patel’s care.
👵 Carer Assessment — Dhruv as a Patient
  • Dhruv is a vulnerable adult in his own right: 76 years old; exhausted; potentially developing his own health problems in the context of caring
  • GP annual review for all registered carers: when did Dhruv last have a check-up?
  • Social services: carer’s assessment (legal right under Care Act 2014); eligibility for respite care, night sitting, day centre attendance for Mrs. Patel
  • Mental health: depression and anxiety extremely common in carers of dying spouses; PHQ-9 and GAD-7 indicated if any concern; bereavement counselling referral
👨‍🏫 Mental Capacity and Decision-Making
  • Mrs. Patel: does she have capacity to make decisions about her care? (MCA 2005: presume capacity; assess if doubt)
  • DNACPR discussion requires capacity: the patient must be able to understand, retain, weigh, and communicate
  • If capacity is compromised (pain; medication; confusion from hypercalcaemia): identify any LPA for Health and Welfare; is there a valid ADRT? Best interests decision if no LPA and no capacity
  • Capacity is time-specific and decision-specific: document assessment carefully
👥 Family Dynamics and Absent Family
  • Daughter in Birmingham arriving next week: what does she know? Has she been told her mother is dying? The GP may need to discuss a family meeting and consider whether Mrs. Patel wants her daughter informed before the visit
  • Conflicting family wishes: family members who demand “do everything” against the patient’s clearly expressed wishes — the patient’s valid, capacitous wish always takes precedence
  • Children of dying adults: are there grandchildren who may need age-appropriate support? Is there a social worker or community support?
  • Cultural differences in family decision-making: some families prefer to make decisions collectively; the patient’s autonomous wish must be kept central
📸 Cultural and Religious Needs
  • Mrs. Patel is Hindu: death and dying are governed by specific religious and cultural practices; ask — do not assume — what is important to her and her family
  • Common Hindu death practices: the body is traditionally washed and prepared by family members of the same sex; many families wish for time with the body; cremation is usual
  • Spiritual care: does she want to see a Hindu priest (pundit)? Is there a local community or religious organisation that can support?
  • Diet and medications: some Hindu patients refuse medications derived from animal products (gelatine capsules; certain injections); check and offer alternatives
GP safeguarding actions in palliative care: assess Dhruv as a patient in his own right at every contact; refer for carer’s assessment (Social Services; Care Act 2014); ensure anticipatory medications are prescribed before the crisis point; brief out-of-hours services; document cultural and religious preferences in care plan; if family dynamics create conflict about care: keep patient’s expressed wishes central; if capacity is in doubt: MCA best interests framework; document all clinical and safeguarding reasoning.
1C — PMH · Drug history · Social history
🥐 Medical and medication history — management impact
FactorWhy it mattersImpact
Renal impairment (eGFR 28 mL/min)Morphine and its active metabolite (morphine-6-glucuronide; M6G) accumulate in renal impairment causing prolonged sedation, myoclonus, hallucinations, and respiratory depression. CKD stage 3b–5: use oxycodone (less reliant on renal excretion of active metabolites; safer in moderate-severe renal impairment) or hydromorphone. Never use morphine for syringe driver in eGFR <30 without palliative care team advice. This is the most critical drug safety point in Mrs. Patel’s case.Switch from morphine to oxycodone SC in syringe driver. Calculate oxycodone dose: oral morphine 120mg/24h ÷ 2 = oral oxycodone 60mg ÷ 1.5 = SC oxycodone 40mg/24h. Seek palliative care team phone advice to confirm.
Current opioid dose and PRN usageMrs. Patel: morphine 20mg every 4 hours = 120mg oral morphine/24h regular. PRN frequency needs to be established: how many breakthrough doses has she taken in the last 24 hours? Add regular + PRN total to establish the true 24-hour opioid requirement. Then convert to the SC equivalent. Convert whole dose with the route correction, not just the regular dose.Opioid calculation: total oral morphine/24h (regular + PRN used) ÷ 2 = oral oxycodone equivalent ÷ 1.5 = SC oxycodone/24h for syringe driver. PRN SC dose = 1/6 of 24h syringe driver dose.
Cancer type and extent of diseasePancreatic adenocarcinoma: pain pattern typically visceral (epigastric, back ache from retroperitoneal involvement); may develop biliary obstruction (jaundice; itch); coeliac plexus involvement (severe refractory pain — may benefit from coeliac plexus block via palliative care/pain team). Hepatic metastases: may cause hepatic capsule pain (shoulder-tip pain; pleuritic; responds to dexamethasone or NSAID). Nausea: cholestasis; raised ICP from liver metastases; opioid-induced. Understanding the cancer biology informs symptom aetiology and treatment.Coeliac plexus pain: refractory; refer to pain team or palliative care for neurolytic coeliac plexus block. Hepatic capsule pain: dexamethasone 8mg OD may help. Biliary obstruction: ERCP stenting — even in palliative phase if jaundice or itch causes significant distress.
Current medications — what can be stopped?Medication review is essential in the palliative phase: many medications taken for chronic disease management are no longer appropriate, beneficial, or able to be swallowed. Statins: no evidence of benefit in the last year of life; stop. Antihypertensives: BP targets become less relevant; risk of symptomatic hypotension at low oral intake; consider stopping or dose reduction. Bone protection (bisphosphonates): may continue for bone pain; no new indication for fracture prevention in last months. Aspirin: consider whether antiplatelet benefit outweighs GI bleeding risk in frail patient. Laxatives: critical to continue — opioid-induced constipation is universal. Make every medication earn its place.Medication review = rationalise to essentials: analgesia; antiemetics; anxiolytics; laxatives; dexamethasone (if indicated). Stop statins; blood pressure medication (if symptomatic); medication requiring monitoring. Document and communicate changes.
🏠 Social history — enabling preferred place of death
FactorWhy it mattersImpact
Carer capacity and availabilityDhruv is 76 and sole carer: his capacity to manage Mrs. Patel at home in the last days of life needs to be honestly assessed. Can he administer SC medications (with nursing supervision)? Can he manage through a night alone? Does he know what to do if she dies at home? Is he physically capable of personal care with nursing support? His wellbeing is both a safeguarding issue and a practical barrier to home death. Honest assessment — with compassion — is better than an optimistic plan that collapses at 3am.Night sitting (Marie Curie; local night nursing services). Community nursing daily visits. Carer’s assessment (Care Act 2014). Respite hospice admission if carer crisis. “Fast-track” discharge (CHC assessment) if significant nursing need — may fund 24-hour care.
Housing and accessibilityIs the house accessible for nursing visits? Can the community nursing team park? Is there a bed downstairs if Mrs. Patel can no longer climb stairs? Is there a hospital bed at home (can be arranged via district nursing or hospice at home)? Is there a commode? Is there adequate heating? These practical barriers prevent home deaths that the patient strongly desires — and a care plan that ignores them will fail.Hospital bed at home: referral via district nursing or hospice at home team. Social services: equipment provision. Occupational therapy: bathroom adaptations; handrails. Stairgate and falls prevention. Community falls alarm (if family not always present).
Out-of-hours notificationWithout an OOH alert: an out-of-hours GP attending Mrs. Patel in crisis will not know her preferred place of death; will not know anticipatory medications are prescribed; may call 999 if she deteriorates; may initiate CPR despite a DNACPR form. The SCR (Summary Care Record) update and OOH alert is as important as any prescription in palliative care. Community palliative care teams often have their own OOH handover — ensure they are alerted and have a current case summary.Update SCR: preferred place of death; DNACPR status; anticipatory medications prescribed; palliative care register; key contact. Alert OOH team: paper or electronic alert. Community palliative care team: ensure OOH handover.
Financial and practical concernsTerminal illness often has financial implications that patients and carers worry about but rarely raise. Dhruv may be managing bills and care costs without support. Benefits: Continuing Healthcare (CHC) assessment if significant nursing needs; Disability Living Allowance or Personal Independence Payment (PIP) if ongoing; Terminal illness benefit rule: DWP DS1500 form (now SR1 form) enables fast-track state benefit access for people with <12 months prognosis. Completion by GP or hospital doctor. Prescription exemption (HC2/FP92A) for all prescriptions. Council tax exemption may apply.SR1 form (formerly DS1500): complete for DWP to enable fast-track benefits for terminal illness. Macmillan social worker (or Citizens Advice Bureau): benefits assessment. Prescription exemption: HC2 form. Continued Healthcare (CHC) assessment if nursing needs significant — fundable 24h care at home or in care home.
1D — ICE
💡 Ideas
"What is your understanding of where things are with your illness at the moment? What has the hospital team told you about what is happening?"
Understanding Mrs. Patel’s illness model is the foundation for all further conversations. Has she been told she is in the last weeks to months of her life? Does she understand that chemotherapy has been stopped because her cancer is not responding, not because she has a different disease? Mismatches between the clinical picture and the patient’s illness model lead to distress, bad deaths in the wrong setting, and failure to plan. The GP who checks first — rather than assuming — avoids the catastrophic error of discussing DNACPR with someone who believes they are going to recover.
😟 Concerns
"What worries you most about what’s happening right now — and about what might lie ahead? Is there anything that frightens you about dying at home?"
Mrs. Patel’s primary concern may not be pain — it may be her worry about Dhruv. She may fear being a burden. She may fear losing consciousness without seeing her daughter. She may fear dying in pain. She may have spiritual concerns about the dying process. Without asking — specifically and compassionately — the GP will address the wrong concerns. The phrase “what frightens you about dying at home?” is powerful: it acknowledges that she knows she is dying, names home death as the plan, and creates space for her real worries to emerge.
🎯 Expectations
"What would a good death look like for you? Is there anything that would be most important to you — anything you’d want to happen, or not happen, in your last days?"
“A good death” is a question that most patients with terminal illness have thought about but rarely been asked. It reveals values that are not otherwise visible: wanting specific family members present; not wanting to be alone; wanting to be conscious until the end; wanting to be fully comfortable and not struggling; specific cultural or religious requirements. These values drive the care plan. A care plan that does not reflect what Mrs. Patel values about dying is not patient-centred care — it is institutional management.
1E — Psychosocial context: dying at home with an exhausted carer
🧑‍🏫 The threat to home death is rarely medical — it is almost always social and psychosocial

Most people who want to die at home and do not achieve it do not fail because of uncontrolled symptoms or medical emergencies — they fail because the carer reaches a breaking point that was not anticipated; because anticipatory medications were not prescribed in time; because the OOH GP who attended did not know the care plan; because a family member panicked and called 999. The GP’s most important role in enabling home death is not prescribing — it is identifying the psychosocial barriers and putting the infrastructure in place before the crisis.

👵 Carer Exhaustion

Dhruv has been caring for his wife through 7 months of illness, including chemotherapy and progressive disability. Carer breakdown is the single most common cause of failure to achieve home death. Assessment: is he sleeping? Is he eating? Does he have anyone to help him? Does he have his own GP? Protective factors: night sitting provision; day hospice attendance for Mrs. Patel; respite admissions.

"Dhruv, I want to check in on how you are doing. You have been doing so much — this is enormously hard. Is there anything you are finding particularly difficult right now? And when did you last see your own doctor?"
🌶 Anticipatory Grief

Both Dhruv and Mrs. Patel are experiencing anticipatory grief — grieving the loss before death has occurred. This is normal and healthy, and it prepares the family for what is coming. But it can be overwhelming and can interfere with practical planning. Psychosocial support: bereavement counselling referral (available before death for anticipatory grief); Macmillan support line; hospice palliative counselling.

"It makes complete sense that you are feeling the weight of all of this — this is the hardest thing that a family goes through. I want you to know that there is support available for both of you, not just Mrs. Patel."
🤝 Family Communication

The daughter in Birmingham does not yet know the gravity of the situation (or does she?). Family communication in palliative care is complex: the patient has a right to decide who is told what, and when. Mrs. Patel may want her daughter called immediately; or she may want to see her in person first. The GP should ask — and document — Mrs. Patel’s preferences for family communication.

"Has your daughter been told how things are at the moment? Would it help to speak to her before she arrives, so she has time to prepare? Or would you prefer to wait and talk when she’s here? Whatever you prefer — this is your decision."
🌟 Spiritual and Cultural Preparation

Dying is not just a medical event. For Mrs. Patel and her family, it is a spiritual and cultural event. Her religious and cultural needs around the dying process and immediately after death need to be documented: who should be present; whether a pundit is needed; what prayers or rituals are important; arrangements for the body. The GP who raises this — sensitively and early — gives the family time to prepare.

"Mrs. Patel, is there anything about your faith or your cultural traditions that you would like us to know about — things that would be important to you and your family as we support you through this time?"
🎓 SCA Checkpoint — Step 1TasksRelating to OthersGlobal Skills
Key phrases that score
"Mrs. Patel, you’ve mentioned a few times that you want to die at home. I want to make sure we do everything we can to make that possible. Can we think together about what would need to be in place — and what might get in the way?"
"Before we talk about anything else — I want to ask how Dhruv is doing. Caring for someone you love through this is incredibly hard. I’d like to make sure he has support too."
"I can see your tablets have not been staying down. I think we need to find a different way of giving you your pain relief — something that doesn’t rely on your stomach."
Deductions
  • Starting with a symptom checklist before acknowledging the journey — scores Relating to Others deduction
  • Not asking about preferred place of death — it was previously discussed; failure to revisit it misses the key advocacy task
  • Not checking what she knows about her prognosis before starting DNACPR discussion
  • Not assessing Dhruv — he is a vulnerable carer and a patient in his own right
  • Prescribing morphine in syringe driver without checking renal function — potentially dangerous (eGFR 28)
🔴 Red
Symptom checklist only; no emotional opener; no preferred place of death; no DNACPR; no carer assessment; morphine prescribed without checking renal function
🟠 Amber
Opened empathetically; explored symptoms; syringe driver recognised as needed; preferred place of death asked; DNACPR conversation started but not completed; carer mentioned but not specifically assessed
🟩 Green
Emotional opener; ICE all three domains explored; syringe driver recognised (renal function checked — oxycodone used, not morphine); anticipatory medications prescribed; preferred place of death explored with barriers named; DNACPR discussion completed; Dhruv specifically assessed; OOH alert planned; community nursing and night sitting arranged; cultural preferences explored and documented
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Step 2
Triage — Palliative Emergency · Urgent Symptom Control · Routine Palliative Review
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Palliative care triage is symptom- and trajectory-led: the clinical question is whether this presentation represents a treatable emergency, urgent symptom control need, or routine palliative review. Mrs. Patel’s inability to absorb oral opioids due to vomiting is an urgent symptom control emergency — not immediately life-threatening, but causing significant uncontrolled suffering that must be addressed today.
🔴 Palliative Emergency

Immediate / 999 / Same-Day Hospital

Act immediately
  • Spinal cord compression — new leg weakness or urinary retentionDexamethasone 8mg immediately; same-day MRI; oncology / neurosurgery referral
  • Massive haemorrhage — tumour erosion of major vesselMidazolam 10mg SC (sedation); dark blanket; 999 if in public setting
  • Hypercalcaemia with confusion or severe symptomsHospital admission for IV fluids and IV bisphosphonate
  • Superior vena cava obstruction — facial oedema; severe breathlessnessDexamethasone 16mg immediately; urgent oncology referral
  • Severe uncontrolled pain crisis — no effective route of administrationSC analgesia from anticipatory medications; if not prescribed: urgent palliative care team advice; consider hospice admission
🟠 Urgent — Mrs. Patel today

Same Day

Same-day community response
  • Vomiting preventing oral medication absorption — syringe driver neededMrs. Patel’s presentation: prescribe syringe driver medications today; arrange community nursing today to set up driver
  • Uncontrolled pain despite adequate opioid prescriptionPRN SC analgesia today; opioid dose review; palliative care team advice
  • Carer breakdown — sole carer reporting inability to continueEmergency respite assessment; hospice admission if no other option
🟩 Routine Palliative Review

Planned GSF Review

Scheduled
  • GSF register review — symptom control; preferences; carer supportPlanned palliative care review; anticipatory medications review; care plan update
  • DNACPR and advance care planning discussionScheduled in a quiet, unhurried consultation — not as an add-on to a routine appointment
  • Medication rationalisation and reviewStop non-essential medications; review analgesia; review antiemetics; laxatives essential
  • SR1 form completion; benefits review; carer’s assessment referralAdministrative palliative care tasks — important but not urgent today
🎓 SCA Checkpoint — Step 2Tasks
Triage for Mrs. Patel
"I can hear that you’ve been struggling to keep your pain tablets down for the last few days — that is not a situation we can leave as it is. What I want to do today is sort out a way of giving you your pain relief that doesn’t rely on you swallowing tablets. That means a small syringe driver under the skin. I would like to get the community nursing team to come and set it up today."
Deductions
  • Sending the patient home without addressing the fact that she cannot absorb her analgesia — this is patient safety failure; she is effectively receiving no analgesia
  • Increasing the oral morphine dose when vomiting is preventing absorption — increasing a dose that is not being absorbed does not help
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Step 3
Examination — Functional Assessment · Signs of Dying · Pain Assessment · Swallowing
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Examination in palliative care is purposeful and patient-centred — every examination finding must inform a specific management decision. Unnecessary examinations in a dying patient cause discomfort without benefit. The key questions: Can she swallow? What is her current functional status? Are there signs of disease complication requiring intervention? Are there signs of active dying?
AssessmentWhat to findFinding changes managementChanges?
Functional status — ECOG performance score0: normal; 1: limited strenuous; 2: ambulatory >50% waking hours; 3: self-care only; 4: bedbound; 5: deadMrs. Patel is ECOG 3 (self-care only; mainly bedbound). ECOG score: determines: (a) prognosis — ECOG ≥3 median survival weeks to months; ECOG 4: days to weeks; (b) route of administration for medications — if ECOG 4, syringe driver is essential and should already be in place; (c) level of community nursing support required — ECOG 3 typically requires daily district nursing; (d) eligibility for Continuing Healthcare funding — significant and rapid functional decline may trigger CHC assessment. ECOG also informs family communication about the expected trajectory.ECOG 3–4: syringe driver needed if oral route unreliable; community nursing daily; consider fast-track CHC assessment; brief family on trajectory. ECOG 4: imminent dying likely; all four anticipatory medications should be immediately accessible.YES — determines urgency of syringe driver and level of community support
Ability to swallowWater test: sip; observe for coughing, choking, gurgling voice; assess oral secretionsThe ability to swallow safely is the gateway criterion for oral medication. If Mrs. Patel has been vomiting for 4 days, oral medications are not being absorbed even if she can physically swallow them. A formal swallowing assessment is not needed — the clinical observation that vomiting is persistent and medications are not reaching the systemic circulation is sufficient to indicate the need for a subcutaneous route. Also relevant: is she at risk of aspiration? Dysphagia in cancer patients can be due to tumour (hepatic or peritoneal mass compressing bowel), opioid-induced gastroparesis, or cachexia.Persistent vomiting with oral medications: convert to SC route (syringe driver). Aspiration risk: review feeding; SLT assessment if recovery is possible. Unable to swallow: all medications must go SC or IV — medication review and conversion required immediately.YES — inability to absorb oral medication = syringe driver today
Signs of acute illness (hypercalcaemia; dehydration; infection)Skin turgor; mucous membranes; temperature; mental stateHypercalcaemia of malignancy: confusion; polyuria; polydipsia; constipation; nausea; dehydration. Corrected calcium is essential (from blood tests) but clinical suspicion should be high in any cancer patient with unexplained confusion or vomiting. Dehydration from vomiting: common; may worsen renal function (already poor at eGFR 28); may require SC fluids (hypodermoclysis) or careful IV rehydration — discuss with palliative care team (fluids in the last days of life can cause fluid overload and respiratory secretions; only indicated if clinical benefit clear). Infection: not always appropriate to treat aggressively in terminal illness — goals-of-care discussion required.Hypercalcaemia suspected: check corrected calcium; if confirmed: hospital admission for IV fluids and IV bisphosphonate. Dehydration without treatable cause: SC fluids at home (hypodermoclysis) may be appropriate if consistent with goals of care. Infection: antibiotics only if symptom benefit outweighs burden — discuss with patient.YES — hypercalcaemia changes urgency; dehydration management depends on goals of care
Signs of approaching death — Cheyne-Stokes; mottling; cooling peripheries; unconsciousnessIn the last hours to days: Cheyne-Stokes breathing (periodic breathing with apnoeic pauses); mottling of knees and feet (livedo reticularis; indicates peripheral circulatory failure); cooling of extremities; changed colour of nails and lips; loss of consciousness; inability to swallow. These signs trigger: (a) syringe driver if not already in place; (b) administration of all four anticipatory medications; (c) family briefing that death is approaching; (d) removal of monitoring equipment; (e) mouth care; (f) positioning for comfort; (g) pastoral/spiritual support; (h) OOH notification that death is expected.Signs of dying present: syringe driver immediately; all four anticipatory medications accessible; discontinue monitoring; family briefed; mouth care; chaplain/pundit if requested; community nursing support intensified; OOH alerted to expected death.YES — dying signs = complete care plan activation and family preparation
Abdominal examination — bowel obstruction; hepatomegaly; ascitesBowel obstruction in advanced cancer (most commonly colorectal or ovarian primary; peritoneal metastases): colic; abdominal distension; no bowel sounds; no flatus. Partial obstruction: conservative management with metoclopramide (stimulates motility) PLUS pain relief; complete obstruction: metoclopramide contraindicated (stimulates against obstruction — worsens colic); use hyoscine to reduce secretions and relieve colic. Hepatomegaly from metastases: hepatic capsule pain (right shoulder-tip radiating; pleuritic quality) — responds to dexamethasone. Ascites: tense ascites may cause discomfort, breathlessness, nausea — paracentesis via hospital or hospice may relieve symptoms even in terminal phase.Bowel obstruction: metoclopramide ONLY in partial obstruction; hyoscine for complete obstruction; consider surgical opinion even in palliative setting if resectable. Hepatomegaly with capsule pain: dexamethasone. Ascites: paracentesis referral via hospital or hospice.YES — bowel obstruction changes antiemetic choice (metoclopramide CI in complete obstruction)
🎓 SCA Checkpoint — Step 3Tasks
Examination rationale
"I’d like to do a brief examination — I want to check your abdomen to make sure there isn’t something specific causing the sickness, and I want to make sure you are not too dry from not keeping things down. I will be gentle."
Deductions
  • Excessive examination in a frail dying patient without clear management intent — causes discomfort; wastes precious consultation time that should be spent on goals of care discussion
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Step 4
Investigations — Only What Changes Management · Renal Function · Corrected Calcium
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The guiding principle for investigations in palliative care: only investigate if the result will change management in a way that is consistent with the patient’s goals of care. Blood tests in the last days of life rarely change management and cause unnecessary pain. But in a patient who is not yet actively dying, targeted investigations can identify treatable complications (hypercalcaemia; renal deterioration; anaemia) that are causing significant symptoms.
InvestigationWhy indicatedResult changes management
Renal function — U&E including eGFR and creatinineMrs. Patel’s eGFR 28 from 3 weeks ago — current value unknown (may have deteriorated with vomiting/dehydration)Renal function in palliative care is the most safety-critical blood test: it determines opioid choice (morphine accumulates in renal impairment — active metabolite M6G causes prolonged sedation, myoclonus, respiratory depression in eGFR <30); it affects dosing of other medications (midazolam accumulates; some antiemetics); it may identify dehydration (elevated urea:creatinine ratio) which is treatable with SC fluids. Mrs. Patel’s eGFR 28 is confirmed CKD 3b: she must not receive morphine in her syringe driver. Repeat U&E today before prescribing syringe driver medications.eGFR <30: use oxycodone SC (not morphine SC); hydromorphone is alternative. Rapidly deteriorating eGFR: suggests dehydration or disease progression; inform prognosis; may indicate days rather than weeks. Normal or stable renal function: morphine cautiously acceptable with careful dose titration and monitoring.
Corrected calciumHypercalcaemia of malignancy: occurs in ~10–20% of advanced cancer patients; must be excluded in any patient with confusion, nausea, vomiting, or polyuriaHypercalcaemia is a treatable oncological emergency that presents with non-specific symptoms (nausea; vomiting; confusion; constipation; polyuria; dehydration) that are easily attributed to disease progression. Treatment (IV fluids + IV bisphosphonate) can dramatically improve symptoms and quality of life within 24–48 hours. Corrected calcium = measured calcium + (0.02 × [40 – albumin]). Threshold for treatment: corrected calcium >2.6 mmol/L with symptoms. Often recurs — may require regular bisphosphonate infusions. Pancreatic cancer: hypercalcaemia less common than bone-metastasising cancers but does occur.Corrected calcium >2.6: hospital admission for IV fluids and IV bisphosphonate (zoledronic acid or pamidronate); oral bisphosphonates are ineffective for acute hypercalcaemia. Corrected calcium normal: look for other causes of vomiting (opioid; obstruction; raised ICP). Recurrent hypercalcaemia: regular IV bisphosphonate schedule.
FBC — if anaemia suspected as cause of fatigue or breathlessnessOnly if result would prompt action consistent with goals of careAnaemia in palliative cancer patients: from bone marrow infiltration; chemotherapy; chronic disease; GI bleeding (rare). Fatigue and breathlessness from anaemia: may be amenable to blood transfusion. The decision to transfuse in a palliative patient requires a goals-of-care conversation: blood transfusion requires hospital attendance (half to full day); may provide 2–4 weeks of symptom relief; is appropriate if the patient’s goals include maintaining function and the transfusion is consistent with their preferences. Do not routinely transfuse without this discussion.Haemoglobin <80 g/L with symptomatic anaemia AND patient wants and can tolerate transfusion: refer for palliative transfusion. Anaemia with poor prognosis and patient focused on comfort: no transfusion; address symptoms (breathlessness with opioids + fans + anxiolytics; fatigue with energy conservation). Thrombocytopenia: bleeding risk; avoid NSAIDs and anticoagulants.
No investigations in the last hours / days of lifeRemove blood test requests if the patient is actively dyingIn the last hours to days of life: blood tests cause pain and distress without any management benefit. Results do not change care (all care is now focused on comfort). Phlebotomy should not be performed. IV cannulae should be removed if not needed for symptom control. Monitoring should be discontinued (pulse oximetry; blood pressure cuffs; blood glucose monitoring). The philosophy shifts from monitoring to comfort: anything that causes discomfort without providing direct comfort benefit should be stopped.Active dying: all investigations stop; all monitoring equipment removed; all non-essential medications stopped; only comfort medications (analgesia; anxiolytic; antiemetic; antisecretory) continue via syringe driver or PRN SC. Death certificate and bereavement support preparation begins.
🎓 SCA Checkpoint — Step 4Tasks
Investigations in palliative care
"I want to take one blood test today — just to check on how your kidneys are doing. The reason I need to know is that some pain medications are cleared by the kidneys, and I want to make sure I prescribe the safest one for you. I don’t want to put you through a lot of tests that won’t change anything — just this one specific test."
Deductions
  • Ordering routine blood tests (LFTs; TFTs; FBC without specific indication) in a patient who is in the last weeks of life — burdensome without benefit; inconsistent with patient-centred palliative care
  • Prescribing syringe driver medications without checking current renal function — safety risk
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Step 5
Recognising Dying — Prognosis · GSF Register · Dying Phase · Plain Language
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The most important clinical skill in palliative care is recognising when a patient has entered the dying phase — and communicating this clearly, compassionately, and in plain language. Mrs. Patel is in the last weeks to months of her life. She needs to know this — at the level of detail she wants — before she can make any meaningful decisions about her care, her family, or her death.
🗣️ Explaining the trajectory — what to say

"I want to be honest with you, Mrs. Patel, because I think you deserve that — and because it helps us plan properly for what is ahead. From everything I am seeing and everything the hospital team has told me, your cancer has progressed to the point where we are no longer trying to treat it and make it smaller — we are now focused entirely on keeping you as comfortable as possible and helping you live in the way that matters most to you. That means we have moved into what we call the palliative phase. Most people in your situation, with the kind of cancer you have at this stage, are thinking about months rather than years — but exactly how long is impossible to say for anyone, and everyone is different. What I can tell you is that we are going to be with you every step of the way."

💬 Common questions — how to respond

"How long do I have?"
"I wish I could give you a definite answer — no doctor can. What I can tell you is that from where things are now, we are thinking about months rather than years — and within that, I want to make sure every week and every month is as good as it can be. Is there something specific you are trying to plan for?"

"I don’t want to know. Just tell me what to do."
"I completely understand — and that is entirely your choice. What I will do is make sure that whatever happens, you are comfortable, you are supported, and you are at home. You do not need to know every detail — we will take it one day at a time."

GSF Prognostic Indicators — enter register
Surprise Question: No

“Would I be surprised if this patient died within 12 months?” Answer No: add to palliative register. Additional GSF triggers: cancer with performance status deterioration; two or more emergency admissions in 6 months; ECOG ≥3; multiple comorbidities with decline. SPICT criteria. NECPAL score. Annual GSF register review mandatory — and at every key deterioration.

Recognising Last Weeks / Days
NICE NG31 indicators

Last weeks: ECOG 3–4; weight loss; reduced intake; bed-bound most of day

Initiate anticipatory medications. Syringe driver if oral route failing. Community nursing daily. DNACPR and ACP conversations. OOH alert. SR1 form.

Last days/hours: mottling; Cheyne-Stokes; not responsive; cold peripheries

All four anticipatory medications accessible immediately. Family briefed. Cultural/spiritual preparation. Mouth care. Stop monitoring. Prepare death certificate.

DNACPR / RESPECT Form
Clinical decision + communication

DNACPR ≠ Do Not Treat

Apply to CPR only. All other treatments continue unless separately discussed. Never ask “do you want CPR?” — frame as clinical recommendation based on patient’s goals. RESPECT form (England; Wales; Scotland): broader; records values and priorities; used by ambulance; OOH; hospital. Must be signed and accessible. Share with patient; family (with consent); OOH; ambulance; community nursing.

📊 Anticipatory Care Planning — conversations to have at each stage
StageKey conversationsDocuments / actions
At GSF register entry (months to years)Preferred place of death; ACP; values and priorities; what patient knows about prognosis; legal documents (LPA; Will)RESPECT form commenced; palliative register; SR1 form; SCR updated; GP annual review; carer’s assessment
At deterioration (last weeks to months)DNACPR recommendation; anticipatory medications; syringe driver plan; family communication; cultural/spiritual preferences; “what does a good death look like?”RESPECT form completed and signed; anticipatory medications prescribed; OOH alert; community nursing referral; night sitting; SR1 form if not done
At active dying (last days to hours)Prognosis in hours not days; family preparation (“this may be her last night”); what to do when death occurs; who to call; not to call 999 if DNACPR in place and expected death at homeAll four anticipatory medications accessible and syringe driver running; OOH notified expected death; death certificate prepared in advance if possible; bereavement support referral for Dhruv; cultural preparation confirmed
🎓 SCA Checkpoint — Step 5TasksRelating to Others
Prognostic discussion phrase
"I want to be honest with you because I think it will help us plan. Where things are now, we are looking at months rather than years. I cannot be more precise than that — nobody can. What I want to make sure of is that those months are as good as possible. Is there anything you want to make sure has happened before then?"
Deductions
  • Asking "do you want CPR?" — the question should never be asked in this way; it shifts a clinical decision inappropriately to the patient and causes distress; the framing is: "I want to make a recommendation about what we do if your heart stops" and then share the clinical reasoning
  • Starting DNACPR without first establishing prognosis awareness
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Step 6
Referral — Palliative Care Team · Hospice · Community Nursing · CHC Assessment
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Palliative care referrals are not a single event — they are a coordinated network of services that must be activated proactively and in advance. The GP’s role is to be the hub of this network: ensuring that the palliative care team, community nurses, OOH services, hospice, social services, and the family all have the information they need to deliver the patient’s preferred care.
ServiceUrgencyWhat GP doesWhat NOT to do
Specialist Palliative Care Team
(hospital or community)
Phone today for advice; formal referral same weekPhone palliative care team today for advice on: (1) syringe driver opioid choice and dosing in context of renal impairment; (2) antiemetic choice for Mrs. Patel’s vomiting pattern; (3) anticipatory medication prescribing. Formal written referral for home or hospice palliative care team review. Include: diagnosis; current medications and doses; renal function; symptom burden; social situation; preferred place of death; DNACPR status. Community palliative care Macmillan nurse: home visit to build therapeutic relationship and plan ahead.Do not prescribe syringe driver medications without palliative care team advice if uncertain about dose conversion or drug compatibility in syringe driver. Do not leave complex opioid calculations to chance — phone advice is available 24 hours/day from palliative care teams in most areas.
District Nursing Team
(community nursing)
Referral today for same-day or next-day visitUrgent district nursing referral today: (1) to set up syringe driver with prescribed medications; (2) to provide daily skin care and pressure area monitoring (Mrs. Patel is mainly bedbound); (3) to support Dhruv with carer training (how to recognise when PRN SC medications are needed; who to call if the driver alarms; what to do when death occurs). District nursing is the backbone of home palliative care — without their regular presence, home death cannot be safely achieved.Do not send Mrs. Patel home with a syringe driver prescription but without arranging community nursing to set it up — Dhruv cannot set up a syringe driver at home and should not be expected to.
Night Sitting Services
(Marie Curie; Hospice at Home; Local authority night sitting)
Referral today for delivery within 48 hoursMarie Curie night nursing (national charity; free; available in most areas): provides trained nurses to sit with the patient overnight, allowing Dhruv to sleep. Referral via GP or district nursing. Hospice at Home: many hospices provide overnight nursing support in the community. Local authority night sitting: for non-clinical needs. These services are essential to prevent carer breakdown — without night support, Dhruv will be unable to sustain home care. Initiate today.Do not assume Dhruv can manage alone through the nights in the last weeks. Night sitting provision is what most commonly makes the difference between a home death achieved and one that collapses with an emergency admission.
Inpatient Hospice AdmissionReferral if: acute symptom crisis; carer breakdown; patient preference; or last days of lifeIndications for hospice inpatient admission: (1) acute symptom crisis not manageable at home (severe pain; refractory nausea); (2) carer breakdown — Dhruv unable to continue; (3) patient preference for hospice death; (4) terminal phase requiring specialist nursing. Hospice admission is not a failure to achieve home death — it is the right care in the right place when home care cannot provide what is needed. Frame as: “the hospice is where the most experienced people are to make sure you are comfortable.”Do not offer hospital as the default when symptoms cannot be managed at home — hospice is the appropriate palliative environment. Do not allow a patient to die in a busy hospital ward without a palliative care specialist involved.
Continuing Healthcare (CHC) AssessmentRefer if significant nursing needs — fast-track pathway availableCHC (NHS Continuing Healthcare): a legal entitlement to full NHS funding of care (at home or in care home) when the primary care need is health rather than social. Terminal illness often qualifies for the fast-track CHC pathway: GP or specialist completes fast-track tool (Form B); can be processed in days; may fund 24-hour home care or fully funded care home placement. For Dhruv: if 24-hour care is needed for Mrs. Patel and he cannot provide it, CHC fast-track may fund professional home carers.Do not expect carers to fund professional home care from their own resources without exploring CHC eligibility. Many families are unaware of this entitlement.
Out-of-Hours GP Service NotificationToday — before Mrs. Patel leaves the surgeryUpdate Summary Care Record (SCR) today: preferred place of death; DNACPR status; anticipatory medications prescribed and their storage location; palliative care team contact; community nursing team contact; “expected death” flag. Paper or electronic OOH alert: some areas have a specific palliative care OOH form. Ambulance alert: where services allow, ambulance service should be notified of DNACPR status so that 999 call in the context of expected home death does not result in resuscitation against the patient’s wishes.Do not delay SCR update to the end of the day — if Mrs. Patel deteriorates tonight and an OOH GP attends, they must have this information before they enter the house.
🎓 SCA Checkpoint — Step 6Tasks
Referral communication to Mrs. Patel and Dhruv
"I am going to arrange for the community nursing team to come to your home today — or at the latest tomorrow morning — to set up the driver and to spend time with you and Dhruv so that you understand exactly what is happening. I will also ask a specialist nurse from the palliative care team to visit you at home — they are the experts in making people comfortable, and they will be a central part of your team from here on. And I am going to update your records so that any doctor who comes to see you — at night or on a weekend — knows exactly what the plan is."
Deductions
  • Not arranging community nursing to set up the syringe driver — it cannot be done by Dhruv or by the GP alone in a community setting; nursing support is essential
  • Forgetting to update OOH records — in the SCA, this is a Tasks criterion; the GP must demonstrate awareness of the whole team, not just today’s prescription
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Step 7
Management — Syringe Driver · Anticipatory Medications · DNACPR · ACP · Carer Support · Safety-Netting
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7A — Address Mrs. Patel’s core concerns before any clinical plan
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Mrs. Patel’s wish to die at home is the foundation of the entire care plan — every clinical decision must be weighed against this
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Validate the wish — take it seriously as a clinical target

Home death is a legitimate and achievable care goal — but only if it is named and planned for explicitly. Most NHS deaths do not happen at home because the system defaults to hospital. The GP who names this as a target, documents it, and builds the infrastructure around it is the most important advocate for a home death.

"You have told me you want to be at home. That is completely understandable and I am going to do everything I can to make that possible. Let me tell you what we need to put in place to give it the best chance of working."
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Be honest about the barriers

A plan that promises home death without acknowledging the real barriers will fail. Dhruv’s capacity; night-time support; anticipatory medications; what to do in a crisis — these must all be named and addressed. Honesty here is kindness: a collapse at 3am and an emergency hospital admission is the worst outcome.

"The main thing that will determine whether you can stay at home is whether Dhruv has enough support — especially at night. I want to make sure we have nursing help in place so that he is not alone managing things."
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Identify what “home” means to her

“Dying at home” means different things to different people: to some it means staying in the house at all costs; to others it means being cared for by people she trusts and not dying alone in a strange place. Understanding what home means — the values underneath the preference — means the hospice option can be offered without it feeling like a betrayal if home death becomes impossible.

"When you say you want to die at home — can I ask what that means to you? Is it being in your own bed, or being close to Dhruv, or being somewhere familiar? I want to understand what is most important so we can protect that, whatever happens."
7B — Goals of care
Palliative care goals
IMMEDIATE: restore pain control via SC route (syringe driver today)IMMEDIATE: control nausea so Mrs. Patel can tolerate the medications she needs SHORT-TERM: enable preferred place of death (home) by putting infrastructure in placeSHORT-TERM: support Dhruv with night nursing to prevent carer breakdown MEDIUM-TERM: DNACPR and RESPECT form completed; OOH notified; SCR updatedMEDIUM-TERM: anticipatory medications prescribed and accessible; family briefed ONGOING: spiritual and cultural needs met; daughter involved with consent; SR1 form for benefitsONGOING: Dhruv assessed as patient in own right; bereavement support planned
Plain language goals for Mrs. Patel
"My job is to make sure you are not in pain, that you are not suffering unnecessarily, and that you can be at home. I can’t change what is happening — but I can make sure that how it happens is as good as it possibly can be."
"The driver we are going to set up — it goes under the skin on your arm or tummy. It runs 24 hours a day and puts your pain medicine directly into your body without needing your stomach. You should feel a lot better within a few hours of it going in."
7C — Non-medication symptom management
😂
Mouth Care
4-hourly swabbing; artificial saliva if available
Why critical

Dry mouth (xerostomia) is one of the most distressing symptoms in the dying phase: caused by mouth breathing; reduced fluid intake; anticholinergic medications (hyoscine). Badly managed dry mouth causes pain, difficulty speaking, and inability to communicate wishes in the last hours. A moisturised mouth is a fundamental comfort measure that any carer can provide.

Practical

Oral swabs (pink sticks) dipped in water or artificial saliva every 1–2 hours. Small sips of water if patient can swallow safely. Lip balm. Ice chips. Teach Dhruv to do this confidently — it gives him a caring role in the last days.

Good mouth care is one of the most important nursing interventions in the last days of life — teach all carers how to do it
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Positioning and Pressure Care
2-hourly turns; pressure-relieving mattress
Mechanism

Bedbound patients develop pressure ulcers (sacrum; heels; occiput; trochanters) rapidly — days to develop in a malnourished, immobile, dying patient. Pressure ulcers cause significant pain and reduce quality of remaining life. Prevention: pressure-relieving mattress (referral via district nursing); 2-hourly repositioning; padding for bony prominences. In the last days: comfort repositioning rather than strict turning schedule.

Practical

District nursing referral: pressure-relieving mattress (air mattress or similar; available via NHS equipment store). Hospital bed at home if needed (via district nursing or hospice at home). Teach Dhruv simple repositioning with a slide sheet. Heels: heel protectors or foam padding under mattress.

Pressure mattress referral via district nursing: essential in any bedbound palliative patient
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Breathlessness Management
Fan; open window; hand-held fan; opioids; midazolam
Evidence basis

Breathlessness in cancer: caused by pleural effusion; lung metastases; anaemia; anxiety; ascites. Non-pharmacological: fan directed at the face (proven effective; stimulates trigeminal receptors that reduce breathlessness perception); open window; upright positioning. Pharmacological: low-dose opioids (morphine 2.5–5mg 4-hrly SC) reduce breathlessness centrally; anxiolytics (midazolam) reduce the anxiety component of breathlessness. Supplemental oxygen: only beneficial if sats <88%; often not helpful and may prolong dying process.

Practical

Provide a small hand-held battery fan for home use. Ensure Dhruv understands how to position Mrs. Patel. If breathlessness worsens acutely in the last days: midazolam PRN from anticipatory medications. Pleural effusion causing significant breathlessness: thoracentesis (palliative drainage) may be appropriate even in terminal phase if it significantly improves quality of life — refer to palliative care team.

Hand-held fan: simple; effective; evidence-based; low-cost; prescribe at every palliative care consultation
🌟
Spiritual and Cultural Care
Ask; document; facilitate; chaplaincy referral
NICE NG31

Spiritual and psychological wellbeing is a clinical domain in palliative care (NICE NG31). The GP who neglects this domain is providing incomplete care. For Mrs. Patel: Hindu tradition; death rituals; pundit; family preparation. For Dhruv: his own spiritual needs; his anticipated role after her death; community support. Chaplaincy referral (hospital or community): not limited to religious patients; includes existential support.

Questions

"Is there anything about your faith or traditions that you would want us to know — things that matter to you at this time?" "Is there a priest or a community member you would want to see?" "Are there things that should or should not happen after you die that we should be aware of?"

Documenting cultural and spiritual preferences: prevents distress and mismanagement at the moment of death and immediately after
👤
Carer Support — Dhruv
Night sitting; respite; carer’s assessment; own GP review
Dhruv as patient

Dhruv is 76 and sole carer. Carers of dying spouses have 4× the risk of depression, anxiety, and physical illness. He is also likely experiencing anticipatory grief. The GP’s duty of care extends to Dhruv: annual carer review; PHQ-9 if depression suspected; referral for carer’s assessment (Social Services; Care Act 2014); registration as a carer on the practice list (triggers QOF carer registers and annual review).

Practical support

Marie Curie night nursing (free; via referral). Day hospice for Mrs. Patel (respite for Dhruv during the day). Carer’s assessment: entitles Dhruv to support in his own right from Social Services. Bereavement counselling referral: available now, before death (anticipatory grief), and after death. Carers UK helpline: 0808 808 7777.

Proactive carer support is the most important factor in enabling home death: without it, home care collapses
📄
Legal and Financial
SR1 form; CHC fast-track; LPA; Will
SR1 form (DWP)

SR1 (formerly DS1500): completed by GP or hospital doctor; sent to DWP; enables fast-track state benefits for patients with a terminal illness (expected prognosis <12 months). Benefits triggered: higher-rate PIP/DLA; Universal Credit terminal illness element; pension credit; Employment and Support Allowance terminal illness component. Prescription exemption: FP92A form (lifetime exemption for cancer patients). Free NHS dental and sight tests.

Legal documents

LPA for Health and Welfare (Lasting Power of Attorney): if not already in place, refer to solicitor or LPA service (GOV.UK — can be done online). Valid only once registered and only activated when the person loses capacity. Advance Decision to Refuse Treatment (ADRT / Living Will): legally binding refusal of specific treatments; must be in writing; signed; witnessed. Will: may want to update — not the GP’s role, but can prompt the patient to seek legal advice.

SR1 form: significant financial benefit for Mrs. Patel and Dhruv; complete at the palliative care consultation
7D — DNACPR and RESPECT form — how to have the conversation
DNACPR is a clinical decision based on whether CPR is likely to be effective and consistent with the patient’s goals — not a question to ask the patient. The correct framing is: "I want to make a recommendation about what we should do if your heart were to stop, and I want to explain my reasoning and understand your views." Never ask "do you want CPR?" — this places an impossible medical burden on the patient. RESPECT form (Recommended Summary Plan for Emergency Care and Treatment): a broader document that captures goals; values; treatment priorities; and CPR decision in one place. Share with patient; family (with consent); OOH; ambulance; community nursing; district nursing.
Opening the conversation

"Mrs. Patel, there is something I need to discuss with you — I want to ask your permission to talk about something that I think is important for us to plan for, even though it is difficult."

"I need to talk about what should happen if you were to have a crisis — if your heart were to stop. I want to explain what would happen, and share my medical view about what would be most helpful for you — and I want to hear your thoughts."

The clinical recommendation

"If your heart stopped, the team would attempt resuscitation — but in your situation, with your illness at the stage it is, I do not think that CPR would help you. It is a very difficult process and would be unlikely to work — and even if it did briefly, it would not change what is happening with your cancer."

"My recommendation is that we do not attempt resuscitation, so that if your heart does stop, we focus entirely on keeping you comfortable and peaceful. All your other care — your pain medication, your nursing, being at home — continues exactly as planned."

Responding to distress or disagreement

"I understand this is very difficult to hear. Can you tell me what you are feeling?"

If patient or family disagrees: explore the concern. Often: they think DNACPR means giving up on treatment (it does not); or they misunderstand what CPR involves (it causes rib fractures; rarely successful in terminal illness). Address each concern directly. The final decision is a clinical one — but patient engagement and shared understanding are essential.

7E — Medication selector — syringe driver and anticipatory medications

Select clinical scenario — syringe driver and anticipatory medication guidance

Syringe driver and anticipatory medication guidance
Syringe driver: convert total 24h oral opioid dose to subcutaneous equivalent (oral morphine ÷ 3 = SC diamorphine; oral oxycodone ÷ 1.5 = SC oxycodone). Renal impairment (eGFR <30): use oxycodone SC NOT morphine SC (M6G accumulation in renal failure causes prolonged sedation and respiratory depression). Always seek palliative care team telephone advice for dose confirmation. PRN dose = 1/6 of 24h syringe driver dose, available every 1 hour if needed. Four anticipatory medications: SC opioid (pain); SC midazolam (agitation/breathlessness); SC antiemetic (nausea); SC antisecretory (secretions). These should be prescribed and accessible at home before they are needed.
7F — Drug reference cards
Oxycodone SC — Syringe Driver (Renal Impairment)
SC oxycodone for syringe driver · preferred over morphine when eGFR <30 · Mrs. Patel’s case
✓ Preferred opioid in renal impairment — less active metabolite accumulation than morphine
First-line SC opioid if eGFR <30; or if morphine causes troublesome side effectsConvert: oral morphine ÷ 2 = oral oxycodone ÷ 1.5 = SC oxycodone/24h; PRN = 1/6 of 24h dose
✓ When to use oxycodone (not morphine)
Renal impairment (eGFR <30): morphine’s active metabolite (M6G) accumulates — causes prolonged sedation; myoclonus; hallucinations; respiratory depression. Oxycodone has less active metabolite accumulation and is safer in moderate-severe renal impairment. Mrs. Patel’s eGFR 28: oxycodone is the correct choice. Oxycodone dose calculation: oral morphine 120mg/24h ÷ 2 = 60mg oral oxycodone/24h ÷ 1.5 = 40mg SC oxycodone/24h syringe driver. PRN SC oxycodone: 40 ÷ 6 = 6–7mg SC every hour as needed. Confirm with local palliative care team — always seek phone advice for syringe driver initiation.
✗ When NOT to use oxycodone alone
Severe renal failure (eGFR <15): all opioids accumulate; specialist palliative care team advice essential; consider fentanyl (renally safe) or alfentanil; do not use without guidance. Never give IV boluses of opioids in community setting — subcutaneous only. Drug compatibility in syringe driver: oxycodone mixes with midazolam and cyclizine in most combinations; does NOT mix well with dexamethasone (precipitate forms) — give dexamethasone SC as a separate injection if needed alongside the syringe driver.
⚠ Side effects
Constipation (universal — prescribe laxative with EVERY opioid; never omit). Nausea (especially on initiation; usually settles; antiemetic for first 2 weeks). Sedation (expected; reassure patient and carer; reduce dose if excessive). Myoclonus (twitching/jerking — sign of opioid toxicity or accumulation; reduce dose; recheck renal function; seek palliative care advice). Respiratory depression (in context of correct dosing for pain: safe; only risk if overtitrated or renal function deteriorates rapidly).
🔬 Monitor
Renal function: repeat U&E if any change in clinical status (deterioration; dehydration). Pain score: at every nursing visit; 4-hourly in the dying phase. PRN SC dose frequency: count number of breakthrough doses every 24h; if >3 PRN doses needed in 24h: increase the regular 24h dose by 30–50% and recalculate PRN. Document all dose changes in the care plan and notify community nursing and OOH.
💬 For Dhruv (explaining the syringe driver)

"The driver goes just under Amrita’s skin — usually her tummy or arm. It runs all the time and puts her pain medicine in continuously. If she seems to be in extra pain, the nurses can give her an extra dose through the driver — that is what the separate ‘top-up’ medicine is for. You do not need to do anything with the driver yourself — the nurses check it every day. If it bleeps or looks different, ring them directly."

Opioid conversion in SCA: oral morphine ÷ 3 = SC diamorphine (where available); oral morphine ÷ 2 = oral oxycodone ÷ 1.5 = SC oxycodone. Renal impairment (eGFR <30): use oxycodone SC not morphine SC — this is the most commonly failed safety criterion in palliative care SCA cases. PRN dose = 1/6 of 24h syringe driver dose. Always state you would seek palliative care team phone advice for dose confirmation — this scores a Tasks mark in SCA.

Midazolam SC — Anxiolytic / Sedative
Anticipatory medication for agitation and breathlessness · syringe driver component · terminal agitation
✓ First-line SC anxiolytic/sedative in palliative care — anticipatory medication for breathlessness and agitation
Anticipatory medication: PRN 2.5–5mg SC; syringe driver 10–30mg/24h if continuous sedation neededPRN: 2.5–5mg SC hourly; syringe driver: 10–30mg/24h titrated; massive haemorrhage: 10mg SC immediately
✓ Indications in palliative care
Anxiety and breathlessness: reduces the anxiety component of breathlessness (not bronchodilator; does not improve oxygen sats; reduces distress). Terminal agitation: PRN 2.5–5mg SC; continuous syringe driver if severe agitation requiring ongoing sedation. Massive haemorrhage: immediate SC midazolam 10mg to relieve distress and sedate; not to stop bleeding. Seizures: midazolam buccal (Epistatus; Buccolam) for acute seizure management at home. Muscle spasm: low doses. Midazolam mixes with oxycodone and with most anticipatory medications in syringe driver — seek palliative care advice on specific combinations.
✗ Cautions
Sedation: expected and may be the therapeutic goal; reassure family that gentle sedation in the last days is comfort, not hastening death. Paradoxical agitation: rare; more common in older patients and those with dementia; if agitation worsens after midazolam: seek palliative care team advice; levomepromazine may be required instead. Respiratory depression: minimal at therapeutic palliative doses when used appropriately; does not hasten death when used to treat genuine symptoms — doctrine of double effect applies.
⚠ Communicating with families about sedation
Families often fear that sedation is “making her die faster.” This is not the case at appropriate palliative doses. Key phrase: “The medicine we are giving is to make sure she is not suffering. It is not to hasten anything — it is so that she is peaceful.” Document in care plan that sedation is for symptom control.
🔬 Monitor
Assess restlessness at every nursing visit: is the patient distressed or comfortable? PRN usage over 24h: if >3 PRN doses in 24h, consider adding midazolam to syringe driver. If agitation worsens despite midazolam: treatable causes (urinary retention; constipation; pain; full bladder); if no treatable cause: seek palliative care team advice about alternative sedatives (levomepromazine; phenobarbitone).
💬 Explaining to family

"This medicine helps with restlessness and breathlessness — it is a gentle sedative. If she looks distressed at any point, the nurses can give it to make her more comfortable. I want to reassure you that this medicine is there to relieve suffering — it is not going to shorten her time."

Midazolam SC: anticipatory medication for agitation and breathlessness in palliative care — one of the four SAAS anticipatory medications. PRN 2.5–5mg SC; continuous syringe driver 10–30mg/24h. Massive haemorrhage protocol: midazolam 10mg SC immediately (sedation; comfort). Paradoxical agitation: rare; seek palliative care team advice; switch to levomepromazine. Families: reassure that sedation relieves suffering and does not hasten death. Document indication clearly in care plan.

Cyclizine SC — Antiemetic (First-Line)
Anticipatory medication for nausea · vestibular and opioid-induced nausea · raised ICP nausea
✓ First-line SC antiemetic in palliative care — effective for opioid-induced; vestibular; and raised ICP nausea
Anticipatory medication: PRN 50mg SC TDS PRN; syringe driver 150mg/24hPRN 50mg SC up to TDS; syringe driver 150mg/24h; do NOT combine with levomepromazine in same driver (antagonise)
✓ When to use cyclizine
First-line antiemetic for opioid-induced nausea (very common); vestibular nausea (movement-induced); raised intracranial pressure nausea. Mechanism: H1 antihistamine + anticholinergic; acts centrally and on vestibular pathways. In syringe driver: compatible with most SC opioids. Standard anticipatory prescription: cyclizine 50mg SC PRN TDS; add to syringe driver as 150mg/24h if nausea is continuous. Mrs. Patel’s vomiting: may be opioid-induced (particularly as oral dose is not being absorbed — cycling of unabsorbed tablets plus sudden SC delivery could cause initial nausea) or due to other causes (hypercalcaemia; raised ICP; gastric outlet; bowel obstruction).
✗ When NOT to use cyclizine
Complete bowel obstruction: cyclizine is not helpful and metoclopramide is contraindicated (stimulates against obstruction); use hyoscine butylbromide for colic and levomepromazine for nausea in this situation. Do NOT mix cyclizine with levomepromazine in the same syringe driver: they antagonise each other and may cause precipitation. If both are needed: use levomepromazine only (it has both antiemetic and sedative properties and is the better single-agent choice for complex symptoms).
⚠ Side effects
Sedation (useful property in palliative care). Anticholinergic effects: dry mouth; urinary retention (particularly in men with BPH — monitor; catheterise if retention). Tachycardia (anticholinergic). Skin reactions at SC injection site (more common with high doses; consider adding hyaluronidase to improve absorption or rotating site).
🔬 Monitoring nausea
Use a validated nausea scale (0–10 verbal rating) at every nursing visit. If cyclizine not controlling nausea after 24–48h: consider alternative antiemetic based on cause — metoclopramide (gastroparesis; partial obstruction); levomepromazine (broad-spectrum; especially in terminal agitation + nausea); ondansetron (not usually first-line in palliative care — causes constipation; less evidence than cyclizine). Contact palliative care team for refractory nausea.
💬 Explaining cyclizine

"This medicine goes into the driver to help with the sickness. It works on the part of the brain and inner ear that controls nausea. She should find that the sickness settles within a few hours of the driver going in."

Cyclizine SC: first-line antiemetic in palliative syringe driver — one of the SAAS anticipatory medications. 150mg/24h in syringe driver; 50mg SC PRN. Do NOT mix with levomepromazine (antagonism; precipitate). Bowel obstruction: levomepromazine + hyoscine butylbromide (not cyclizine; not metoclopramide in complete obstruction). Causes of nausea in cancer: opioid-induced (most common); raised ICP; hypercalcaemia; bowel obstruction; gastric outlet obstruction — each has a different antiemetic approach.

Hyoscine Butylbromide SC — Antisecretory (“Death Rattle”)
Buscopan · SC antisecretory for terminal secretions · also relieves bowel colic
✓ SC antisecretory for terminal secretions — one of four SAAS anticipatory medications
Anticipatory medication: PRN 20mg SC; syringe driver 60–120mg/24hPRN 20mg SC up to 4-hrly; syringe driver 60–120mg/24h; also use for bowel colic in obstruction
✓ Terminal secretions (“death rattle”)
Terminal secretions (rattling breathing from pooling of oropharyngeal secretions in an unconscious patient): one of the most distressing sounds for carers and families to hear; patient is typically unconscious and not distressed but sound is alarming. Mechanism: pooling of saliva and secretions as swallowing reflex is lost. Hyoscine butylbromide (Buscopan): SC antisecretory; does not cross blood-brain barrier (therefore less sedating than hyoscine hydrobromide); reduces secretion production. Also use in bowel obstruction: hyoscine butylbromide reduces intestinal secretions and relieves smooth muscle colic in bowel obstruction. NB: not the same as hyoscine hydrobromide (Kwells): the hydrobromide form crosses the BBB and causes more sedation; preferred in some palliative protocols but less commonly stocked.
✗ Important distinctions
Hyoscine BUTYLBROMIDE (Buscopan) ≠ Hyoscine HYDROBROMIDE. They have different properties: butylbromide does not cross BBB (less sedating; more local antisecretory effect); hydrobromide does cross BBB (more sedating; preferred by some palliative teams for refractory secretions with agitation). Check your local palliative care formulary for which is stocked. Glycopyrronium bromide: alternative antisecretory; fewer anticholinergic CNS effects; preferred in some guidelines. All three are effective; choice depends on local protocol and availability.
⚠ Managing family expectations
The “death rattle” is NOT a sign that the patient is choking or drowning. Explain to Dhruv: “The sound you are hearing is not Amrita struggling — she is not distressed. It is the way breathing sounds when someone is very deeply unconscious. We can give her a medicine to reduce it, but I want you to know that she is not in pain.” This reassurance is as important as the medication.
🔬 Monitor
Repositioning: head elevation and gentle repositioning to one side may reduce pooling and improve air flow — should be attempted before or alongside medication. Suction: NOT recommended in terminal care; distressing; not effective; may prolong distress. Oral hygiene: gentle mouth care (not suction) for patient comfort. Review hydration: reducing IV/SC fluids may reduce secretion volume. PRN hyoscine: give first PRN dose and review at 30 minutes; if effective, commence syringe driver.
💬 For Dhruv

"The noise you can hear is coming from Amrita’s throat — it is not a sign that she is struggling. We are going to give her a medicine to dry up those secretions. Please know that she is not distressed or in pain."

Hyoscine butylbromide (Buscopan): SC antisecretory — SAAS anticipatory medication for “death rattle” (terminal secretions). 20mg SC PRN; 60–120mg/24h syringe driver. Distinguish from hyoscine hydrobromide (more CNS sedating; different preparation). Reassure family: “death rattle” is not patient distress — family education is as important as the medication. Bowel obstruction: hyoscine butylbromide reduces secretions and colic; metoclopramide contraindicated in complete obstruction.

Morphine — Oral and SC (Standard Renal Function)
Gold-standard opioid · oral morphine for stable patients · SC diamorphine (preferred) for syringe driver · NOT in renal impairment
✓ First-line opioid for palliative pain; AVOID if eGFR <30 (use oxycodone instead)
First-line opioid in patients with normal renal function; oral or SC; widely availableOpioid naïve: 2.5–5mg oral 4-hrly + 2.5–5mg PRN hourly; SC diamorphine: oral dose ÷ 3
✓ Opioid naïve dosing and titration
Starting dose (opioid naïve): oral morphine 2.5–5mg every 4 hours PLUS 2.5–5mg PRN every hour for breakthrough pain. Review after 24h: add total PRN doses used to regular dose to calculate new 24h need; divide back into 4-hourly doses (or convert to modified-release preparation once stable: oral MR morphine twice daily). Syringe driver conversion: total 24h oral morphine ÷ 3 = 24h SC diamorphine for syringe driver. Diamorphine preferred (highly water soluble; small volume; mixes well). Where diamorphine unavailable (shortage; some areas): use morphine sulphate SC — different conversion (oral ÷ 2 for SC morphine; less soluble; larger volume).
✗ Critical: morphine in renal impairment
ABSOLUTE CONTRAINDICATION in eGFR <30: morphine’s active metabolite M6G (morphine-6-glucuronide) accumulates and causes prolonged sedation; myoclonus (involuntary twitching); hallucinations; respiratory depression; respiratory arrest. Mrs. Patel’s case: eGFR 28 = DO NOT USE MORPHINE. Switch to oxycodone SC. If already on oral morphine (as in Mrs. Patel): convert to SC oxycodone for syringe driver. Never continue SC morphine in a patient whose renal function deteriorates to eGFR <30 without seeking palliative care team advice immediately.
Accumulation signs: increasing sedation beyond what is expected; myoclonus (twitching); confusion; pinpoint pupils; reduced respiratory rate. If these appear in a patient on morphine: withhold next dose; seek palliative care team advice urgently; check renal function; consider naloxone if respiratory depression (use cautiously — may precipitate acute pain crisis).
⚠ Side effects — counselling for all opioids
Constipation: UNIVERSAL; prescribe laxative (co-danthrusate; senna + docusate; movicol) at EVERY opioid prescription; constipation is never acceptable in palliative care. Nausea: common on initiation; usually settles within 2 weeks; prescribe antiemetic for first 2 weeks. Sedation: expected; usually settles; if persisting or worsening: opioid toxicity or accumulation — reduce dose or switch opioid. Itch: from histamine release; antihistamine. Urinary retention: particularly in men; monitor.
🔬 Monitoring opioid therapy
Pain score at every nursing visit (0–10 NRS). PRN dose frequency: if >3 PRN doses in 24h: increase 24h regular dose by 30–50% and recalculate PRN. Signs of accumulation: increasing sedation; myoclonus; confusion — reduce dose; recheck renal function. Respiratory rate: monitor in new patients or after dose increases. Document all changes; notify community nursing and OOH.
💬 Counselling

"These tablets are strong pain medicines. I want to tell you what to expect: they may make you a little sleepy at first, which is normal. Some people feel a bit sick in the first few days — I am giving you some medicine for that. They will also make you constipated, which is why I am giving you a laxative at the same time. Please do not stop them without telling me, even if you feel the pain has settled."

Morphine: gold standard palliative opioid; CONTRAINDICATED in eGFR <30 (M6G accumulation). Opioid naïve: start 2.5–5mg oral 4-hrly + PRN. Syringe driver: total oral dose ÷ 3 = 24h SC diamorphine. Always prescribe laxative. PRN breakthrough = 1/6 of 24h dose. Accumulation signs: myoclonus; sedation; confusion — reduce dose; check renal function. Constipation is never acceptable — laxative with every opioid prescription.

Dexamethasone — Multiple Palliative Indications
Oral or SC · spinal cord compression · SVCO · raised ICP · appetite · nausea · hepatic capsule pain
✓ Versatile corticosteroid — multiple palliative indications; review dose regularly; taper before stopping
Multiple indications: dose and duration depend on indication — see belowMSCC emergency: 8mg stat then 16mg/day oral; SVCO: 16mg/day; Appetite/fatigue: 2–4mg OD morning; ICP: 8–16mg/day
✓ Palliative indications and doses
Spinal cord compression (MSCC): dexamethasone 8mg IMMEDIATELY on suspicion; do not wait for MRI. Continue 16mg/day (4mg QDS) while awaiting definitive treatment (radiotherapy; surgery). Reduces peri-tumour oedema; preserves neurological function. SVCO: 16mg/day immediately; reduces peri-tumoural oedema; oncology referral for radiotherapy ± stenting. Raised ICP from brain metastases: dexamethasone 8–16mg/day; headache; early morning vomiting; altered consciousness. Appetite stimulant: dexamethasone 2–4mg OD in the morning (short-term; effect wanes after 4–6 weeks; side effects limit long-term use). Hepatic capsule pain: 8mg OD; reduces peri-hepatic inflammation; useful adjunct to opioids for this specific pain. Nausea: dexamethasone 4–8mg SC; antiemetic via multiple mechanisms; useful adjunct in refractory nausea.
✗ Cautions in palliative care
Do not combine with NSAIDs (GI bleeding risk); prescribe PPI gastroprotection (lansoprazole 15–30mg OD) with all palliative dexamethasone. Do not give in syringe driver with opioids (precipitate); give as a separate SC injection or switch to oral route. Do not stop abruptly after prolonged use (adrenal suppression; taper dose over days to weeks).
Diabetes: steroids cause significant hyperglycaemia; increase monitoring; insulin adjustment may be needed. Oral candidiasis: prescribe nystatin mouthwash prophylactically. Insomnia: take in the morning to minimise sleep disruption. Psychosis: may exacerbate in susceptible patients; monitor mental state. Fluid retention and hypertension: monitor in patients with cardiac history.
⚠ Review at 5–7 days
Dexamethasone must be reviewed: is there benefit? Has the indication resolved (e.g. MSCC treated with radiotherapy)? Taper if stopping to avoid adrenal crisis. Benefit for appetite: usually wanes after 4–6 weeks. In terminal phase: may be stopped (unless clear comfort benefit) as side effects (myopathy; oral candidiasis; glucose dysregulation) outweigh benefit. Discuss with patient before starting: realistic expectations about duration and expected benefit.
🔬 PPI gastroprotection mandatory
Prescribe lansoprazole 15mg OD (or omeprazole 20mg OD) with ALL dexamethasone courses in palliative care — GI ulceration risk; NSAID combination is particularly high risk. Monitor for diabetes if on prolonged course — random glucose or capillary glucose at each nursing visit.
💬 Counselling

"This is a steroid tablet — we use it for several things in your situation. It should help with your appetite and reduce some of the discomfort around your liver. Please take it in the morning with food. I will also prescribe a stomach protection tablet to go with it. I want to review it in a week to make sure it is helping."

Dexamethasone: multiple palliative indications. MSCC: 8mg IMMEDIATELY on suspicion (before MRI) — this is a time-critical SCA task. SVCO: 16mg/day immediately; oncology referral. Appetite/fatigue: 2–4mg OD morning; review after 5–7 days; wanes after 4–6 weeks. Hepatic capsule pain: 8mg OD. Always: PPI gastroprotection; take in the morning. Do not give in syringe driver with opioids (separate SC injection). Do not stop abruptly (adrenal suppression). Review at 5–7 days.

7G — Psychosocial impact of terminal illness
🤝
The impact of dying on the person, their family, and their future
Terminal illness is not just experienced by the patient. Dhruv is also profoundly affected — both in the current caring role and in the anticipated bereavement. The GP’s role is to hold both Mrs. Patel and Dhruv in care simultaneously: managing physical symptoms and simultaneously attending to the social, psychological, cultural, and spiritual dimensions of dying.
🧑‍🏍
Carer (Dhruv)

Dhruv is experiencing anticipatory grief; physical exhaustion from caring; isolation; and the terror of being alone with his dying wife. He needs active support from the GP team — not just as Mrs. Patel’s carer, but as a vulnerable adult in his own right. He needs to know who to call in a crisis (community nursing OOH line; not 999 if expected home death). He needs to know what death will look like so he is not terrified when it happens.

"Dhruv, how are you sleeping? When did you last have a chance to look after yourself? I want to make sure you have support too — this is the hardest thing there is."
👥
Family Communication

The daughter in Birmingham is coming next week and does not yet know the severity of the situation. Mrs. Patel needs to decide — with the GP’s support — what she wants her daughter to know and when. Preparing family members for what they will see when they arrive (how her mother will look; how ill she is) prevents traumatic shock on arrival and enables a purposeful visit.

"Would it be helpful if we wrote to your daughter together — or I could call her — to help prepare her before she arrives? I want her visit to be a good one for both of you."
🌟
Spiritual and Cultural Preparation

Hindu death practices: the body is typically bathed and prepared by family immediately after death; a priest (pundit) may be required; cremation is usual and may have specific timing. The GP who has documented these preferences — and who has alerted the community and nursing team — ensures that the patient’s cultural needs are met without distress in the immediate period after death. Do not make assumptions — ask.

"Is there a pundit or someone from your community you would want to see before that time, or when the time comes? And are there things we should know about what should happen to Amrita’s body and how you would like things to be?"
💔
Anticipatory Grief and Bereavement Planning

Bereavement support should be initiated before death, not only after. Referral to Macmillan palliative counsellor or Cruse Bereavement Support for Dhruv now — before the death — means support is already in place for the period immediately after. GP also plays a key role: bereavement contact call at 2 weeks; mental health review at 6 weeks; antidepressant discussion if grief is becoming complicated bereavement (prolonged; impairing function beyond 6–12 months).

"When the time comes, and after, I want to make sure you are not alone, Dhruv. I am going to refer you to a counsellor who can support you through this — starting now, not after."
7H — Follow-up
T
Today — Syringe driver initiation and anticipatory medications

Confirm renal function (U&E); confirm syringe driver medications (oxycodone SC + midazolam + cyclizine + hyoscine butylbromide); prescribe all four anticipatory medications; arrange district nursing today to set up syringe driver; update SCR with DNACPR status; preferred place of death; anticipated medications; OOH alert; night sitting referral (Marie Curie); DNACPR/RESPECT form discussed and completed; SPECT palliative care referral; SR1 form completed.

Syringe driver setup by community nursing: same dayOOH alert and SCR update: before end of surgery day
2
24–48 Hours — Syringe driver review; pain and nausea reassessment

Phone or home visit: is the syringe driver running? Is Mrs. Patel’s pain controlled? Is nausea settling? How many PRN doses have been used? If >3 PRN doses in 24h: increase 24h syringe driver dose by 30–50%. Dhruv: how is he managing? Night sitting in place? Palliative care Macmillan nurse: has she visited? RESPECT form: has Dhruv received a copy?

Opioid dose review: count PRN doses used in first 24h
3
Weekly — GSF register review; symptom assessment

Weekly GP review or community nurse review: symptom burden (pain; nausea; breathlessness; secretions); ECOG functional status; DNACPR and care plan review; carer support (Dhruv); daughter’s visit — how did it go? Any change in preferred place of death? Spiritual and cultural needs: has the pundit visited? Benefits (SR1 form submitted). Medication rationalisation: which medications can now be stopped?

GSF review: weekly once actively dying; RESPECT form review
4
At Deterioration — Brief family on expected death; last days care

When active dying signs appear (mottling; Cheyne-Stokes; unconscious; cold peripheries): OOH service notified of expected death; family briefed on what to expect and what NOT to do (do not call 999 if DNACPR in place and home death expected); all four anticipatory medications accessible and PRN available immediately; syringe driver running; mouth care explained to Dhruv; chaplaincy / pundit alerted.

Active dying: all four anticipatory medications immediately accessible; OOH notified
5
After Death — Death certification; carer support; bereavement

Death certification: GP must attend to verify death (Medical Certificate of Cause of Death; MCCD) or arrange cremation medical forms if required; anticipated home death should be straightforward. Dhruv: bereavement call at 2 weeks; GP review at 6 weeks (complicated grief; depression; physical health); ensure Macmillan/Cruse bereavement counsellor is engaged. Statutory notifications if required (coroner: if GP has not seen patient in 28 days or uncertain cause of death; report to coroner, not police, for unexpected death even at home in palliative setting).

Death certificate; 2-week bereavement call; 6-week GP review for Dhruv
7I — Monitoring — GSF SAAS rule

Memory rule — SAAS anticipatory medications

Palliative anticipatory medications: Subcutaneous opioid (pain); Anxiolytic (midazolam — agitation; breathlessness); Antiemetic (cyclizine or levomepromazine — nausea); Secretions (hyoscine butylbromide — terminal secretions). Prescribe all four before they are needed. Syringe driver renal rule: eGFR <30 → oxycodone SC (not morphine); eGFR >30 → morphine SC or SC diamorphine. Opioid calculation: oral morphine ÷ 3 = SC diamorphine; oral oxycodone ÷ 1.5 = SC oxycodone. PRN = 1/6 of 24h driver dose.

Drug classMonitoring parameterTimingAction threshold
SC opioids (oxycodone; morphine)Pain score (0–10); PRN dose frequency; sedation level; respiratory rate; myoclonusEvery nursing visit (minimum daily); 4-hrly in dying phase>3 PRN doses/24h: increase 24h driver dose by 30–50%. Myoclonus / sedation: opioid accumulation; reduce dose; recheck renal function; seek palliative care team advice
Renal functionU&E; eGFR — determines opioid safetyAt driver initiation; if clinical deterioration or dehydrationeGFR <30: switch from morphine to oxycodone SC; escalate to palliative care team if eGFR rapidly declining
Midazolam (anxiolytic)Level of agitation or restlessness; wakefulness; paradoxical agitationEvery nursing visit; 4-hrly in dying phaseParadoxical agitation (worsens with midazolam): seek palliative care team advice; switch to levomepromazine. Insufficient sedation: increase dose or add to syringe driver
DexamethasoneBlood glucose; symptom response; side effects (candidiasis; oedema; psychosis)Review at 5–7 days; monthly if ongoingNo symptom benefit at 5–7 days: taper and stop. Glucose >12: insulin adjustment. Oral candidiasis: prescribe nystatin
ECOG StatusLevel of community support neededGP action
ECOG 0–1 (ambulatory)Outpatient palliative care; clinic review; Macmillan nurseGSF register; DNACPR discussion; ACP; anticipatory medications prescribing
ECOG 2 (limited activity)Weekly district nursing; day hospice; carer supportReview medications; anticipatory medications written; OOH alert; SR1 form; night sitting referral
ECOG 3 (mainly bed/chair — Mrs. Patel)Daily district nursing; night sitting; anticipatory medications in place; syringe driver likely needed soonSyringe driver plan; all four anticipatory medications prescribed; OOH alert; family briefed on dying process; carer’s assessment
ECOG 4 (bedbound)Syringe driver running; nursing visits TDS — QDS; night sitting every night; hospice if home not feasibleExpected death notification OOH; all medications in place; family preparation for death; cultural/spiritual preparation
Active dying (mottling; Cheyne-Stokes)Continuous nursing if possible; family present; all PRN medications immediately accessibleOOH notified expected death; 999 NOT to be called (if DNACPR home death expected); mouth care; chaplain/pundit; death certificate preparation
7J — Safety-netting

⚠ Three critical safety-net conversations for palliative care

🔴 Emergency — Spinal Cord Compression (new neurological symptoms)
"If Amrita develops any new weakness in her legs, numbness, or if she is unable to pass urine, please ring me immediately — or take her to hospital. Do not wait for an appointment. This is a type of emergency that we can treat, and how quickly we act makes a real difference."
MSCC is an oncological emergency where early steroid treatment and radiotherapy can restore or preserve neurological function. The window is hours. If Dhruv does not know the symptoms to watch for — or that he should act immediately — the opportunity is lost. Pre-written dexamethasone 8mg in the anticipatory medications (or prescription held by district nursing) means it can be given immediately at home before the ambulance arrives.
💉 Syringe driver — what to do if it alarms or stops
"If the driver makes a noise or the display looks different — do not touch it yourself; ring the community nursing team directly on this number [provide]. They are available 24 hours. The number for the palliative care team is [provide]. If Mrs. Patel seems to be in pain or distressed and you cannot reach the nurses immediately, you can give her the extra injection the nurses have shown you — but ring them straightaway."
Syringe driver alarms at night are one of the most common sources of crisis for families managing home death. Dhruv needs a single piece of paper with: the community nursing out-of-hours number; the local palliative care team number; the PRN injection instructions; and what NOT to do. Without this, a minor driver issue becomes a 999 call.
🟠 What to do when death occurs at home
"When the time comes — and this is important, Dhruv — you do not need to ring 999. A death at home that is expected is not an emergency. Ring the community nursing team to come and verify death and support you. Ring me in the morning and I will come to complete the certificate. You can take the time you need with Amrita before anyone else needs to come."
Many home deaths are turned into traumatic emergency responses because the family does not know what to do and calls 999. Paramedics may then feel obliged to resuscitate unless the DNACPR form is immediately visible (and in some areas even then). Dhruv must know: expected home death = ring community nursing team, not 999; DNACPR form must be visible (bedside or on the fridge). This is one of the most important conversations in home palliative care.
TodaySyringe driver set up; DNACPR; SCR update; OOH alert; all four anticipatory medications in house
24–48hPain and nausea reassessment; PRN count; opioid dose review; night sitting confirmed
WeeklyGSF review; ECOG reassessment; carer (Dhruv) check-in; daughter’s visit debrief
🎓 SCA Checkpoint — Step 7 (Final)TasksRelating to OthersGlobal Skills
Closing the consultation
"Let me bring together what we have agreed today. I am going to arrange for the community nurses to come and set up the driver today or first thing tomorrow. I am prescribing the medications for it — including the pain medicine and the sickness medicine. I am also prescribing ‘just-in-case’ medicines so that if you need something quickly, the nurses can give it at home without waiting."
"We have completed the DNACPR form together — and I want to make sure you know: that is ONLY about resuscitation. Everything else — your pain medicine; the nurses; being at home — continues exactly as before. The form means that if you were to die peacefully at home, there would be no emergency ambulance called unnecessarily."
"I have updated your records so that any doctor who comes to see you — at night or on a weekend — knows what your plan is, and that you want to be at home."
"Dhruv — I want to check in with you. Is there anything you are worried about for the nights ahead? And I’m going to arrange for a night nurse to come and sit with Amrita so that you can rest. That is not a failure — it is an essential part of the plan."
"Before you go — is there anything that I haven’t addressed? Anything you have been worried about that we haven’t spoken about today?"
Deductions
  • Prescribing morphine SC in a patient with eGFR 28 — potentially dangerous; oxycodone required
  • Not completing DNACPR / RESPECT form — key task in this scenario; not completing it means Mrs. Patel is at risk of unwanted CPR
  • Not addressing preferred place of death explicitly — it was previously discussed and documented; revisiting it is essential as it may have changed
  • Sending patient home without arranging community nursing to set up syringe driver — critical failure of care co-ordination
  • Forgetting to assess or support Dhruv — carer assessment is a Tasks criterion; he is a vulnerable adult and a patient in his own right
Tasks — full criteria
  • Syringe driver initiation with renal function checked (oxycodone not morphine)
  • All four SAAS anticipatory medications prescribed and accessible
  • DNACPR / RESPECT form completed with patient
  • Preferred place of death explored; barriers named and addressed
  • Community nursing arranged same day for driver setup
  • OOH alert and SCR updated before end of day
  • Carer (Dhruv) explicitly assessed and supported
Relating to Others
  • Emotional opener before symptoms
  • ICE all three: prognosis awareness; fears explored; what a good death means
  • DNACPR framed as clinical recommendation; not a question
  • DNACPR ≠ Do Not Treat clearly explained to patient and Dhruv
  • Dhruv addressed directly and compassionately
  • Cultural and spiritual needs explored
  • Closing question asked with genuine pause
🔴 Red
Morphine SC prescribed with eGFR 28; no DNACPR discussion; preferred place of death not addressed; syringe driver prescribed but community nursing not arranged; Dhruv not mentioned; emotional opener absent
🟠 Amber
Oxycodone SC prescribed correctly; syringe driver initiation recognised; DNACPR discussed but not completed; preferred place of death mentioned; Dhruv's carer role acknowledged but not specifically assessed; OOH alert forgotten
🟩 Green
Emotional opener; ICE all three explored; oxycodone SC (not morphine) — renal function cited; all four SAAS anticipatory medications; DNACPR / RESPECT completed with explanation (not = Do Not Treat); preferred place of death with barriers addressed; community nursing arranged today; night sitting (Marie Curie) referred; OOH alert and SCR updated; Dhruv assessed; cultural/spiritual preferences; closing question with genuine pause
Palliative Care — SCA Consultation Scorecard
NICE NG31 · NG142 · NG184 · GSF · SAAS Anticipatory Medications · Opioid Conversion · DNACPR · Syringe Driver
0/ 33 pts
🌐
Global Skills
Structure, language, whole-person care
0/7
Tasks
Clinical reasoning, prescribing, co-ordination
0/15
🤝
Relating to Others
Compassion, communication, shared decisions
0/11
RAG Self-Assessment
🔴 Red
Morphine SC prescribed with eGFR 28; no DNACPR discussion; preferred place of death not addressed; community nursing not arranged for syringe driver; Dhruv not mentioned; emotional opener absent; OOH not updated
🟠 Amber
Oxycodone SC correctly chosen; syringe driver initiated; DNACPR mentioned but not completed; preferred place of death revisited; community nursing discussed but not confirmed for same day; Dhruv’s role acknowledged; OOH alert forgotten
🟩 Green
Emotional opener; ICE all three; prognosis awareness checked; oxycodone SC (renal function cited); all 4 SAAS anticipatory medications; DNACPR/RESPECT completed; PPD with barriers addressed; community nursing same-day; night sitting; OOH alert and SCR updated; Dhruv assessed; cultural/spiritual preferences; bereavement referral; closing question; SR1 form; safety-net for when death occurs
011172533
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"I’m so sorry — I have been finding it very hard to get here. The pain has been awful these last few days. And I can’t keep my tablets down at all."
Who you are

Mrs. Amrita Patel, 74, retired schoolteacher. You were diagnosed with pancreatic cancer 7 months ago. You had chemotherapy but the consultant told you a few weeks ago that it was not working and they were stopping treatment. You know your cancer is “not curable” — the word “dying” has not been said explicitly, but you know in your heart that this is where things are going. Your husband Dhruv, 76, is in the waiting room. He is struggling. You have one daughter, Priya, who is a teacher in Birmingham. She is coming to visit next weekend. She does not yet know how serious things are — you have been protecting her. You want to die at home. You do not want to die in hospital. You are not frightened of death itself — you are frightened of dying in pain and of leaving Dhruv alone.

Hidden agenda — disclose only if asked directly and with warmth

Priya (disclose if asked about family): “My daughter is coming at the weekend. She doesn’t know — I haven’t told her how bad things are. I don’t want her to worry.” If GP asks: “Would it help if we spoke to her together, or helped her understand before she arrives?” — Mrs. Patel becomes visibly relieved: “I think … I think I want her to come sooner. I’m not sure I have until the weekend.” This is the emotional heart of the consultation.

Dhruv (disclose if asked about carer support or nights): “He’s not sleeping. He is up every time I make any noise. I feel guilty — he is 76 and he is not well himself.” If GP says they will arrange night nursing: visible relief. “He won’t accept help — I need you to tell him it is OK to accept it.”

Fears about the syringe driver (disclose if asked about the driver or concerns): “My sister had one when she died. I thought it was what killed her. Is that … is that what happens?” This misunderstanding is very common and must be addressed directly. If GP explains clearly that the driver is for pain control and does not hasten death: Mrs. Patel accepts it.

Responses to key clinical conversations
  • On DNACPR framed as “do you want CPR?”: distressed; confused; “I don’t know — what would happen?”; escalates anxiety. If framed as clinical recommendation with clear reasoning: “I don’t want machines doing things to me — I just want to be comfortable and at home”; agrees
  • On syringe driver (after reassurance about driver not hastening death): “If it means I won’t be in pain — yes. Whatever it takes.”
  • On prognosis (if asked what she knows): “They said the chemo wasn’t working. I think … I think we’re running out of options. Am I right?”; if GP confirms directly and compassionately: tears; then “How long?”
  • On cultural preferences (Hindu traditions): “I want a pundit — not afterwards, now. I would like him to come soon. And when I die — please don’t move my body before Dhruv and Priya have had time with me.”
Clinical details
  • Age 74; metastatic pancreatic adenocarcinoma; ECOG 3; mainly bedbound
  • Current morphine: 20mg 4-hrly = 120mg oral morphine/24h (but has not been absorbing it; 4 days of vomiting)
  • Renal function (3 weeks ago): eGFR 28 — CKD 3b — CRITICAL for opioid choice
  • BP 98/62; HR 88; temp 36.7; weight (last recorded 3 weeks ago): 52 kg
  • No signs of hypercalcaemia; no neurological symptoms; no signs of MSCC; no bowel symptoms suggesting obstruction
  • PMH: type 2 diabetes (metformin — should now be stopped given renal function and nil by mouth); hypertension (amlodipine — consider stopping)
"Are you saying I’m going to die soon? What does soon mean? I was hoping to see Priya — she’s coming at the weekend. Does she need to come sooner? Do I need to call her tonight?"

Resolution: Mrs. Patel agrees to the syringe driver once the misunderstanding about it hastening death is resolved. She agrees to the DNACPR form. She asks the GP to help contact Priya to come sooner — and the GP does this with her, in the consultation. She is relieved about the night nursing for Dhruv. She leaves with a plan she understands, her fear of uncontrolled pain addressed, and a phone number to call at any time. She says: “I want you to know — I am not afraid to die. I just want to be ready.”

🏥
Clinic Quick Reference
Palliative Care — GP Framework
NICE NG31 · NG142 · NG184 · GSF · Opioid conversion · SAAS · RESPECT · MSCC · SVCO
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🚨 1 — Triage Algorithm
Palliative patient → Surprise Question ⇒ Assess symptom burden ⇒ Route of administration viable? ⇒ Renal function (eGFR) ⇒ Opioid conversion ⇒ Anticipatory SAAS ⇒ DNACPR + RESPECT ⇒ OOH alert ⇒ CHC fast-track
Surprise Question: “Would you be surprised if this patient died in the next 12 months?” — No = register on GSF palliative register; trigger anticipatory care planning
Oral route failing (vomiting; dysphagia; reduced GCS): switch to subcutaneous via syringe driver — convert all oral opioids to SC; prescribe anticipatory SAAS medications; check eGFR before selecting opioid
Renal impairment (eGFR <30): morphine is CONTRAINDICATED — M6G accumulates (sedation; myoclonus; respiratory depression); use SC oxycodone instead; do not use diamorphine as substitute in severe renal failure
Anticipatory SAAS (prescribe before needed): SC opioid (pain); SC midazolam (agitation / breathlessness); SC cyclizine or haloperidol (nausea); SC hyoscine butylbromide (secretions) — all four should be prescribed and available at home
DNACPR: frame as clinical recommendation — “We would not attempt CPR”; never “Do you want CPR?”; DNACPR ≠ Do Not Treat; applies to CPR only; all other symptom management continues
RESPECT form: broader than DNACPR — records values, goals, priorities, preferred place of care, ceiling of treatment; share with patient, out-of-hours team, ambulance, community nursing
OOH palliative alert · CHC fast-track assessment · Expected home death — do NOT call 999; ring community nursing team · Bereavement follow-up for family within 2 weeks
💊 2 — Opioid Conversion Table
Starting opioidConversionResultKey condition
Oral morphine÷ 3= SC diamorphine (24h syringe driver)Avoid if eGFR <30 (M6G accumulation)
Oral morphine÷ 2= Oral oxycodone (24h)
Oral morphine÷ 3 (oral morphine ÷ 2, then ÷ 1.5)= SC oxycodone (24h syringe driver)Preferred in eGFR <30
Oral oxycodone÷ 1.5= SC oxycodone (24h)
Mrs. Patel example: Oral morphine 120mg/24h + eGFR 28 → oral morphine ÷ 2 = 60mg oral oxycodone ÷ 1.5 = 40mg SC oxycodone/24h. PRN dose = 40 ÷ 6 = ~7mg SC oxycodone hourly
💭 3 — Anticipatory SAAS Medications
S — Subcutaneous opioidA — Anxiolytic / sedativeA — AntiemeticS — Antisecretory
SC oxycodone (eGFR <30) or SC diamorphine (normal renal) — PRN dose = 24h total ÷ 6Midazolam 2.5–5mg SC PRN (agitation; breathlessness; terminal restlessness)Cyclizine 12.5mg SC PRN; or haloperidol 500mcg–1mg SC PRN. Do NOT mix cyclizine + levomepromazine in same syringe (antagonism)Hyoscine butylbromide 20mg SC PRN; also via syringe driver for secretions (“death rattle”)
🚨 4 — Oncological Emergencies
EmergencyFirst actionDrugKey rule
MSCC (Malignant Spinal Cord Compression)Dexamethasone 8mg IMMEDIATELY on clinical suspicion; MRI same dayDexamethasone 8mg IV or oral — before imagingDo NOT wait for MRI to start dexamethasone — irreversible cord damage if delayed
SVCO (Superior Vena Cava Obstruction)Dexamethasone 16mg immediately (higher dose than MSCC)Dexamethasone 16mg oral or IVHaematology / oncology / stenting — urgent 999 if severe respiratory compromise
Hypercalcaemia of malignancyIV fluids + IV bisphosphonate (hospital)IV pamidronate or zoledronic acidOral bisphosphonates are NOT effective acutely; this is a hospital treatment
📋 5 — DNACPR and RESPECT
DNACPR ≠ Do Not Treat — CPR only; all other care continues Never ask “Do you want CPR?” — frame as clinical recommendation: “We would not attempt resuscitation” RESPECT: records values + goals + preferred place of care + ceilings; share with OOH + ambulance + community nursing Advance Decision to Refuse Treatment (ADRT): legally binding if valid + applicable; must be documented Expected home death: do NOT call 999 — ring community nursing team; GP verifies death and issues MCCD SR1 form (formerly DS1500): fast-track DWP benefits for <12 months prognosis — complete without patient request
🚵 6 — Syringe Driver (Addressing Misconceptions)
A syringe driver delivers medication continuously under the skin — it is NOT an end-of-life decision and does NOT hasten death. It is used when the oral route is no longer reliable (vomiting; dysphagia; reduced consciousness). The medications it delivers (opioids for pain; anxiolytics for distress; antiemetics for nausea; antisecretories for secretions) are all individually familiar and intended to maximise comfort. The doctrine of double effect applies where appropriate: symptom control that incidentally shortens life is ethically and legally distinct from euthanasia. If the patient or family asks about the driver: “The syringe driver means the medicines go in more reliably — it doesn’t change what the medicines do or what they are for.”

CHC fast-track: for patients with rapidly deteriorating terminal condition with significant nursing needs; may fund 24-hour home care. Refer via CHC fast-track form. MCA 2005: 5 principles · ADRT: legally binding · LPA: registered + activated; check before acting against wishes · Best interests decision if no capacity and no ADRT/LPA

🎓
SCA Exam Quick Reference
Palliative Care SCA — Opioid Conversion · SAAS · Renal · DNACPR Framing
NICE NG31 · NG142 · eGFR <30 = oxycodone (not morphine) · Syringe driver does not hasten death
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💬 Opening & ICE
Opening — Mrs. Patel: “I want to talk with you today about how things are going — and to make sure we have a proper plan in place so that you are as comfortable as possible at home. I am also going to ask you some things that might feel difficult — I hope that is OK.”
ICE — Ideas: “What do you understand about how your illness is progressing? Has anyone talked with you about where things are heading?” — establishes what Mrs. Patel already knows; do not assume
ICE — Concerns: “What worries you most at the moment — is it the pain, or is it something else?” — Mrs. Patel’s real concern is Priya (not yet told), Dhruv’s exhaustion, and dying at home; the pain is a clinical task but not the ICE answer
ICE — Expectations: “Is there anything specific you’d want from today? Anything that would make this week feel more manageable?”
Values and preferred place: “Have you had any thoughts about where you’d want to be, when the time comes — at home, or somewhere else?” and “Are there any religious or cultural traditions that are important for us to know about?” — Mrs. Patel is Hindu; explore family rituals, spiritual needs
Challenge line: “Are you saying I’m going to die soon? Does Priya need to come sooner?”
“I think the honest answer is yes — I think it would be good for Priya to come soon. I don’t know exactly when, but I want to make sure the people who love you are with you. What would it take for Priya to come?”
Dhruv’s carer needs: “How is Dhruv coping with all of this? I want to ask because sometimes it’s hard to see when someone who loves us is struggling — and there is support available that I’d like to tell you both about.”
✅ Key SCA Tasks (15pt)
Identify oral route failure (2pt): 4 days of vomiting = oral medications unreliable; switch to SC route via syringe driver — not a crisis, a logical route change
Renal impairment + opioid safety (2pt): eGFR 28 = morphine contraindicated (M6G accumulates); select SC oxycodone; NOT diamorphine in severe renal failure
Opioid dose conversion (2pt): oral morphine 120mg/24h ÷ 2 = 60mg oral oxycodone ÷ 1.5 = 40mg SC oxycodone/24h; PRN = 40 ÷ 6 = 7mg SC hourly — this calculation is SCA-examinable
SAAS anticipatory prescribing (2pt): all 4 before needed: SC opioid (pain); midazolam (agitation); cyclizine or haloperidol (nausea); hyoscine butylbromide (secretions)
DNACPR framing (2pt): clinical recommendation framing; never “Do you want CPR?”; DNACPR ≠ Do Not Treat — CPR only; all other care continues; DNACPR discussed sensitively with Mrs. Patel first, then family
Preferred place of care + RESPECT (2pt): explore preferred place of death; document in RESPECT form; share with OOH + ambulance + community nursing; identify barriers (night cover; carer capacity)
Carer support — Dhruv (1pt): carer exhaustion; CHC fast-track assessment for home nursing; carer assessment; suggest Priya visits sooner with Mrs. Patel’s agreement
OOH palliative alert + anticipatory medications in situ (1pt): OOH team alerted; community nursing team informed; medications prescribed and available at home before needed
SR1 form (formerly DS1500) (1pt): fast-track DWP benefits for terminal illness (<12 months prognosis); complete without patient’s request
🔴 Never use morphine SC in eGFR <30 — M6G accumulation; sedation; myoclonus; respiratory depression
🔴 Never mix cyclizine + levomepromazine in same syringe driver — precipitation / pharmacological antagonism
🔴 Metoclopramide in complete bowel obstruction — prokinetic; contraindicated; use haloperidol for nausea instead
👥 Relating to Others (11pt)
DNACPR language (2pt): “We would not attempt resuscitation — this is because we do not believe it would work, and attempting it would not be in keeping with the way you want to spend this time”; never “Do you want CPR?” — that question makes patients responsible for a clinical decision and causes immense distress
Syringe driver (2pt): “A syringe driver is a small pump that delivers your pain medicine under the skin continuously — it is not an end-of-life decision, and it does not mean we are giving up or hastening anything. It just makes sure your medicines work more reliably than trying to swallow them” — addressing this without being asked is the mark of an excellent palliative care communicator
Honest prognosis (2pt): when asked directly (“Am I going to die soon?”) — honest, compassionate, specific where possible but acknowledging uncertainty: “I think we are measuring in weeks to months rather than months to years. I can’t say exactly. What I can say is that I want to make sure we are completely prepared”
Dhruv’s needs (2pt): Dhruv is 76, exhausted, sole carer — naming this directly: “I am also worried about Dhruv. He is doing so much. Would it be all right if I spoke to him about some of the support that is available? Accepting help is not giving up — it is making sure this can work the way you both want it to”
Family dynamics (Priya) (1pt): Priya is in Birmingham; does not know the full severity — “I want to ask about Priya. Does she know how things are at the moment? I wonder if it would help if she came sooner rather than later — and whether there is anything I can do to make that conversation easier”
Cultural sensitivity (1pt): Hindu traditions — ask about religious practices, family roles, rituals — “Are there any religious or cultural things that are important to you as we plan care — people or rituals you’d want involved?”; never assume; family may have strong views about disclosure; navigate with Mrs. Patel’s guidance
Not overwhelming in one visit (1pt): this consultation covers opioid switch, DNACPR, syringe driver, Priya, and Dhruv — a skilled clinician signals structure: “There are a few things I want to cover today; I’ll go through them one at a time and check in with you as we go”
🟩 Realistic outcome: Mrs. Patel agrees to syringe driver; DNACPR discussion begun; RESPECT started; Priya call planned; Dhruv’s carers assessment arranged
💊 Drug Quick-Pick
Reviewed: July 2026 · citations verified against current NICE / UK guidance