Areas for guidance
4.3 Facilitating discussions
Future care should be planned with a view to enabling the person with dementia to live as well as possible right up until they die. As outlined in section 3, conversations on future and end-of-life care should be a natural extension of the regular care planning discussions healthcare staff have with the person (9,21). These discussions may relate to what is important to the person with dementia in the forthcoming days or could specifically relate to the care they would like to receive if they became unwell. There will be some people who do not wish to or are reluctant to discuss any aspect of end- of-life care (9) and this should be respected, but the option to revisit this subject should always remain open. Similarly, it is important not to assume that a person does not want to plan for their future care because they have not initiated a discussion (15,72). As discussed in section 3, healthcare staff may feel ill equipped and reluctant to approach this sensitive topic (15,19,24,25). The barriers experienced by staff in discussing end-of-life care with people were explored in an Irish study (16). This study highlighted staff’s concerns about their use of language, how to sensitively introduce the topic and how to respond to questions that challenge them. These fears/anxieties can be explored through the use of reflective practice which allows for personal and professional development thus enabling practitioners to provide high standards of care (74). St Vincent’s Hospital in Athy developed prompts for assisting staff in holding discussions which address future and end-of-life care planning (16). This can be seen in more detail overleaf.
GUIDANCE – FACILITATING DISCUSSIONS 1. Use team meetings and case reviews to reflect with other staff on situations where opportunities to discuss end-of-life care can be optimised. 2. Develop ‘end-of-life care’ domain questions as part of care planning documentation, and prepare sentence prompts to facilitate discussions on end-of-life and future care planning. 3. Review documentation to determine the extent that end-of-life discussions are discussed, recorded and followed through. 4. Access communication and training opportunities to support discussions on end-of-life care for the person with dementia.
Facilitating discussions on future and end-of-life care with a person with dementia
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