Structure Overview:

• Introduction
• Information Gathering
• Delivering Information (Warning Shot)
• Explore end of life views
• Explain EOL Care
• See the Patient Together

Introduction

• “Thanks for meeting with me. Would you like anyone else to be here with you?”

Information Gathering

• Clarify current understanding of the situation.
  “Before we start, can you tell me what you already know about what’s been happening?”
• Ask about baseline health and function: “How was your [loved one] managing day to day before this illness?”
• Explore end-of-life wishes:
  • “Has your [relative] ever spoken about what they would want if they became very unwell?”
  • “Do they have an Advance Care Directive or Power of Attorney?”
    
    

Delivering Information (“Warning Shot”)

• Gently prepare: “I’m afraid I have some difficult news.”
• “Your [relative] is very sick, and I’m worried they may be nearing the end of their life.”

Explore views on end of life

• “At this stage, it’s looking less likely that further treatment will help.”
• “What do you think your [relative] would have wanted if their younger self could sit here with us and tell us?”
• “Knowing their quality of life as it is now, would they want to come back to hospital for more treatment, or would they prefer to die peacefully at home?”
• “I’m worried we’re not prolonging their life, but actually prolonging their dying.”

Guide Through EOL Care

• Discuss next steps:
  • Comfort-focused care / palliative approach
  • Referral to palliative care team
  • COSA chart (comfort observations) for monitoring
• Address symptom control:
  • Pain – regular analgesia
  • Agitation – benzodiazepines, reassurance
  • Breathlessness – opioids, positioning, fan
  • Secretions – anticholinergics
  • Carer stress – ongoing support and respite

See the Patient Together

• “Let’s go and see your [relative] together.”