Background Surprisingly there is a very limited evidence base concerning the symptoms that patients who are dying experience. The Liverpool Care Pathway (LCP) utilised the evidence derived from patients cared for in a hospice setting, arguably patients with more complexity of symptoms than those that might die elsewhere and predominantly patients with cancer. The rapid discharge service in Leicestershire accepts adult patients with any diagnosis thought to be in the last 48 h of life who wish to die at home. All patients are cared for using the LCP and anticipatory medications for symptom management are dispensed on discharge.
Aims To review the symptoms that arose in patients sent home from hospital who were in the last phase of life.
Methods Case notes were reviewed for 23 consecutive patients referred in three months to the rapid discharge service. Symptoms were identified through the LCP documentation and use of drugs noted.
Results Eight died before discharge. Six of the 15 discharged had cancer. Other patients had a very eclectic range of illnesses. Non cancer patients lived longer than cancer patients (mean 4.8 vs 1.8 days). Only one patient had a syringe driver on discharge but 11 in the last 24 h. All patients required at least one drug for symptom management. Only one needed haloperidol (for nausea). 14/15 patients required pain relief, but the majority of non-cancer patients received a higher dose of morphine in the last 24 h than cancer patients. The symptom burden of non-cancer patients, with some exceptions was greater and required higher doses of drugs in the last 24 h than cancer patients.
Conclusions The symptom management of cancer patients who came home to die required lower doses and fewer drugs than non-cancer patients. The terminal phase for non-cancer patients is longer and their symptom burden is greater.
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