@article {DaviesA352, author = {Nathan Davies and Kethakie Lamahewa and Rammya Mathew and Jane Wilcock and Jill Manthorpe and Elizabeth L Sampson and Steve Iliffe}, title = {14 Managing uncertainty in care for people with dementia at the end of life: the use of heuristics}, volume = {7}, number = {3}, pages = {A352--A352}, year = {2017}, doi = {10.1136/bmjspcare-2017-001407.14}, publisher = {British Medical Journal Publishing Group}, abstract = {Introduction The end of life for someone with dementia can present several challenges for practitioners. Challenges may be eased with the use of heuristics (rules-of-thumb). For example, FAST is used in stroke: Facial-weakness, Arm-weakness, Slurred-speech, Time to call 999. Our study developed a toolkit of heuristics to aid practitioners making difficult decisions when caring for someone with dementia at the end of life.Methods A co-design approach with three phases:1. Focus groups and semi-structured interviews with family carers and practitioners, to identify key decisions and how these should be made.Results were presented to a co-design group consisting of health and care practitioners, and family carers tasked with developing a toolkit of heuristics, through workshops.2. Testing the heuristics in practice for six-months in five clinical and care settings.3. Evaluation of heuristics through interviews and questionnaires at three and six-months.Results Four sets of heuristics were developed, covering; eating/swallowing difficulties, agitation/restlessness, reviewing treatment, and routine care. The heuristics are arranged as flowcharts. Eating/swallowing difficulties have two rules; ensuring eating/swallowing difficulties do not come as a surprise and reflection about {\textquoteleft}comfort-feeding{\textquoteright} only. Agitation/restlessness encourages a holistic approach, considering the environment, physical causes, and caregivers{\textquoteright} health/wellbeing. Reviewing treatment/interventions prompts practitioners to consider the benefits to quality-of-life and comfort. Finally, routine care, such as bathing, prompts practitioners to ensure care interventions improve or do not harm quality-of-life.Conclusions Practitioners liked the simplicity of the heuristics, making their implicit knowledge explicit, enhancing their confidence in making decisions at the end of life.}, issn = {2045-435X}, URL = {https://spcare.bmj.com/content/7/3/A352.1}, eprint = {https://spcare.bmj.com/content/7/3/A352.1.full.pdf}, journal = {BMJ Supportive \& Palliative Care} }