Practice Essentials

Supporting relatives and carers at the end of a patient’s life

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j367 (Published 02 February 2017) Cite this as: BMJ 2017;356:j367
  1. M Berry, specialist trainee in anaesthesia and intensive care1,
  2. E Brink, senior social worker, adults with physical disabilities team2,
  3. J Harris, counselling and psychotherapy practitioner, and bereaved mother and daughter3,
  4. K E Sleeman, clinician scientist and honorary consultant in palliative medicine4
  1. 1Imperial School of Anaesthesia, London, UK
  2. 2Cambridge County Council, Cambridge, UK
  3. 3Beyond Goodbye Project, Stroud, UK
  4. 4King’s College London, Department of Palliative Care Policy and Rehabilitation, Cicely Saunders Institute, London, UK
  1. Correspondence to K Sleeman katherine.sleeman{at}kcl.ac.uk
  • Accepted 9 December 2016

What you need to know

  • Effective support can make a considerable difference to the relatives of people who are dying; helping to allay fears, reducing stress and anxiety, and minimising suffering in bereavement.

  • Clear communication around practical considerations (death certificate, funeral arrangements, information around autopsy, etc) and psychosocial support (normalising grief, cultural and spiritual considerations) is key.

  • Doctors need to familiarise themselves with local systems and protocols. Written communication in addition to verbal is beneficial.

“How people die remains in the memory of those who live on” — Cicely Saunders

All doctors, irrespective of their specialty or the setting in which they work, will care for patients who die. Around half of all deaths occur in hospitals.1 Evidence suggests that the quality of communication around this process is poorer in hospitals than in other settings, according to responses from relatives who have experienced bereavement.2 Over half of NHS complaints concern care of the dying.3

This article discusses how to best support relatives and carers at the end of a patient’s life. While the focus is on the hospital setting, the principles are applicable to community and care home settings. In this article, “relative” encompasses family members, care givers, and those close to the patient. The article presumes throughout that the patient has given consent for information to be shared with relatives (Box 1).

Box 1: Consent, capacity, and confidentiality

Consent

Consent must be given voluntarily, by an appropriately informed person who has capacity. Consent cannot be given on behalf of others except

  • if the patient is a child under 16,

  • someone is authorised to give consent under a lasting power of attorney,

  • someone has the authority to make treatment decisions as a court appointed deputy.4

Capacity

A person who lacks capacity is unable to make a decision for themselves because of an impairment or disturbance in the functioning of …

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