GuidelinesPrimary Care STG
End of Life Care
End of Life Care
Z51.5
The management of a patient who is imminently terminal (death suspected to occur within a few days or weeks), should include:
- Communicating honest, direct, compassionate, and culturally sensitive information regarding the prognosis and symptoms that might develop.
- Relieving physical, spiritual, and emotional distress in the patient and family.
- Treating easily manageable complications that cause suffering.
- Stopping all unnecessary medicines.
- Limiting hospital admissions, if possible.
- Ensuring that parents/caregivers are adequately counselled.
- Decision-making as to the preferred place of death (home, hospice, hospital) and referral to community-based services where available (hospice, palliative, and home-based care services).
Indications for referral for in-patient hospital or hospice care:
- Hypoxia and respiratory distress where oxygen therapy provides relief. IV/nasogastric fluid requirements or medication administration needed to relieve suffering.
- Carer/s unable to cope at home.
Feeds and fluids at the end of life:
- Anorexia and refusal of feeds/fluids in dying patients is a normal phenomenon.
- Encourage the family to feed for comfort only and reassure them that the dying patient is not hungry.
Investigations at the end of life:
- Investigations should be kept to a minimum and only done if it might contribute to the patient’s comfort.
Antibiotics at the end of life:
- Oral antibiotic therapy might not be indicated. Refer to the patient’s palliative care plan if available, or consult a palliative care trained doctor.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.6 End of Life Care