Headlines: March 18th, 2005

Health and social care services are failing to meet the needs of chronically ill people close to death, according to research published today by a team from the University of Edinburgh. They claim, too, that doctors feel they are helplessly reduced to performing routine tasks as a patient’s death approaches.The researchers, whose findings are published in the British Medical Journal, call for active and supportive care by doctors and medical services in the community for people who are thought likely to die.

Dr Scott Murray, a family doctor and palliative care researcher at the University, describes what he identifies as the state of ‘prognostic paralysis’, in which doctors of patients with such conditions as severe heart failure or progressive lung disease find it difficult to take an active approach to care, or to discuss end-of-life issues because the prognosis for the patient is uncertain.

Dr Murray describes how one general practitioner summarised the feelings that many doctors experience in caring for those with terminal heart failure patients when he said it was like ‘paddling downstream to Niagara.’ Another practitioner felt reduced to undertaking clinical tasks, saying, ‘I feel impotent, merely a blood leech and monitor’.

Dr Murray and his co-researchers suggest the means to overcome this are both active treatment and supportive care by doctors, practice and community nurses for those patients that are identified as being likely to die within 12 months.

“Palliative care in the community could then be more extensive and proactive,” he says. “Most people with progressive chronic illnesses have already brushed with death. On the one hand, they hope that things will not deteriorate, but at the same time they know that death is inevitable.”

Dr Murray says greater awareness of these conflicting thoughts should make it easier for professionals to combine active treatment and a supportive approach to patients. People with disabling, progressive illnesses, he says, expect active care but are also looking for comfort, control and dignity.