RT Journal Article
SR Electronic
T1 Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 294
OP 300
DO 10.1136/bmjspcare-2012-000253
VO 2
IS 4
A1 Ubogagu, Edith
A1 Harris, Dylan G
YR 2012
UL http://spcare.bmj.com/content/2/4/294.abstract
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.