GPs told to quiz elderly with serious health problems about 'how they want to die'
Questions: Doctors are being told to ask elderly patients with serious health problems if they want 'do not resuscitate' orders put in their medical files (posed by models)
GPs must ask the elderly with serious health problems if they want ‘do not resuscitate’ orders put in their files, according to senior doctors.
They should also find out if patients want to die at home and whether they would rather refuse certain drugs or treatment in their final hours.
Doctors who carried out a study found discussions about death helped prevent thousands of elderly patients being admitted to hospital against their will.
There are concerns frail patients are being forced to remain on wards until they die and are given medical treatment that only prolongs their agony.
But many doctors are reluctant to talk to their patients as death is seen as a taboo subject.
Last week figures from the Office for National Statistics showed just a fifth of patients are dying at home – even though nearly three quarters wanted to. This number is far lower than in countries elsewhere in the Western world.
Dr Adrian Baker and researchers from the Universities of Aberdeen and Stirling are calling for more GPs to draw-up ‘end of life’ plans for seriously-ill patients.
This includes those with a range of health problems such as dementia, cancer, heart disease or diabetes, who are frequently in and out of hospital.
The researchers – whose recommendations are backed by the Royal College of GPs and published in the British Journal of General Practice – say family doctors should ask patients and their relatives if they would rather not be resuscitated should their condition suddenly deteriorate.
They also want GPs to help patients draw up ‘living wills’ whereby they can decide to refuse antibiotics, being fed through a tube or put on a ventilator. And they want doctors to check patients know they are dying and ensure they make a record of where they want to end their lives.
All about choice: Dr Adrian Baker said the plans were good way of looking at options available so that the wishes of loved ones are fully respected
The researchers carried out a study of 10,800 elderly patients which showed those with so-called ‘anticipatory care plans’ were more than three times as likely to die at home. In addition they were less likely to be taken to hospital – but if they were admitted they tended to be discharged sooner.
Dr Baker, who practises as a GP in Nairn in the Scottish Highlands, said: ‘Today’s NHS is all about choice, but few patients seem to understand the choices available to them in their final few months.
‘Anticipatory care plans are a good way of looking at the options available with a view to ensuring the wishes of loved ones are fully understood by everyone involved in their care, so unplanned hospitalisation can be avoided.
‘We are faced with an ageing population, which is estimated to see 22 per cent of the population aged over 65 years by 2035.
‘GPs have knowledge of a patient’s full medical history and often have a relationship based on trust. They are uniquely placed to broach this issue to help ensure their final wishes are met.’
Davina Hehir, director of policy at Dignity in Dying, said: ‘There is no doubt that discussing end-of-life preferences can be difficult both for the patient and their doctor.
‘However, such conversations have an important part to play in helping ensure that dying patients’ wishes are respected.’
Last year the RCGPs asked family doctors to pledge to treat dying patients with dignity. They were urged to promise to preserve patients’ ‘independence, dignity and sense of personal control’.