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In a review of Changing Gear (Revised version. Ed. Ellershaw) published by the National Council on Palliative Care, Dr. Gillian Craig, MD, FRCP, makes ten points, of which we only have space for three:
“1. This publication highlights some principles for the care of people dying of malignant disease and non-malignant disease in hospitals, care homes, private residences and hospices, as set out in the Liverpool Care Pathway. This approach is being promoted throughout the country with government backing, a stated aim being to reduce emergency admissions and reduce transfers of patients from care homes to hospital at the end of life. . . . .
“4. Changing Gear has remarkably little to say about the value of hydration at the end of life. The guidelines fail to mention the work of Fainsinger and Bruera who give subcutaneous hydration to all their dying cancer patients who are dehydrated or at risk of becoming so, and by so doing reduce the incidence of distressing terminal delirium.
“5. Changing Gear fails to mention that subcutaneous hydration can be given in the patient’s home to prevent dehydration, fails to list thirst as a commonly reported symptom (see p.10), and considers it ‘best practice’ to discontinue intravenous infusions in the last hours or days of life (p.18). This advice is dangerous, for it can be difficult to predict how long a patient has to live. . . .”
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