PT - JOURNAL ARTICLE AU - Ubogagu, Edith AU - Harris, Dylan G TI - Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care AID - 10.1136/bmjspcare-2012-000253 DP - 2012 Dec 01 TA - BMJ Supportive & Palliative Care PG - 294--300 VI - 2 IP - 4 4099 - http://spcare.bmj.com/content/2/4/294.short 4100 - http://spcare.bmj.com/content/2/4/294.full SO - BMJ Support Palliat Care2012 Dec 01; 2 AB - Objective Terminal haemorrhage is a rare and distressing emergency in palliative oncology. We present an algorithm for the management of terminal haemorrhage in patients likely to receive end-of-life care at home, based on a literature review of the management of terminal haemorrhage for patients with advanced cancer, where a DNAR (do not attempt resuscitation) order is in place and the patient wishes to die at home. Method A literature review was conducted to identify literature on the management of terminal haemorrhage in patients with advanced cancer who are no longer amenable to active interventional/invasive procedures. Electronic databases, the grey literature, local guidelines from hospitals and hospices, and online web portals were all searched systematically. The literature review was used to formulate a management algorithm. Results The evidence base is very limited. A three-step practical algorithm is suggested: preparing for the event, managing the event (‘ABC’) and ‘aftercare’. Step 1 involves the identification and optimisation of risk factors. Step 2 (the event) consists of A (assure and re-assure the patient), B (be there – above all stay with the patient) and C (comfort, calm, consider dark towels and anxiolytics if possible). Step 3 (the aftercare) involves the provision of practical and psychological support to those involved including relatives and professionals. Conclusion Terminal haemorrhage is a rare yet highly feared complication of advanced cancer, for which there is a limited evidence base to guide management. The suggested three-step approach to managing this situation gives professionals a logical framework within which to work.