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Letter
Predicting the last days of life will change clinical practice
  1. Séamus Coyle1,2 and
  2. Elinor Chapman3
  1. 1 University of Liverpool, University of Liverpool Marie Curie Palliative Care Institute Liverpool, Liverpool, UK
  2. 2 Willowbrook Hospice, Prescot, UK
  3. 3 Palliative Care Institute, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Séamus Coyle, Palliative Care Institute, University of Liverpool, Liverpool L3 9TA, UK; s.coyle{at}liverpool.ac.uk

https://doi.org/10.1136/bmjspcare-2020-002187

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    Dying patients can have distressing symptoms, and medications exist to control them. Dying needs to be actively managed—there is no such thing as ‘nothing more can be done’. Yet, recognising dying is difficult. No objective diagnostic test exists, and there is often huge uncertainty. Knowing if a person is dying is crucial for patients, their families, the medical teams and clinicians to plan and provide the best care.

    The current standard to predict dying is the best guess of at least two members of the multidisciplinary team. Physicians predictions are frequently inaccurate and overoptimistic.1 2 A systematic review that included 1.2 million patients demonstrated that non-beneficial antibiotics, cardiovascular, digestive and endocrine treatments to the dying occurred in 11%–75% (mean 38%).3

    Despite decades of cancer research, little is known about how people die …

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    Footnotes

    • X @elinorchapman

    • Contributors Both authors wrote the survey. EC conducted the survey electronically. Both authors cowrote the letter.

    • Funding This study was funded by Wellcome Trust (Grant number: 202022/Z/16/Z).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.