The Dying Patient

Authors: Thomas Mac Mahon / Editor: Frances Balmer / Codes: Published: 06/06/2023

The care of patients who are at the end of their lives or dying in the emergency department (ED) is a key responsibility of all emergency medicine clinicians.

This learning session explores how to recognise patient trajectories as they approach the end of their lives, as well as the diagnosis of dying. It goes on to outline a practical yet comprehensive jigsaw approach to all facets of palliative care in the emergency department, including legal aspects, spiritual and emotional care as well as symptom management and communication skills.

Learning objectives:

  • Recognise dying and patients at the end of their lives
  • Communicate effectively and empathetically with patients and their relatives
  • Appreciate the range of sources to determine a patients care wishes, and their legal standing
  • Use pharmacologic and non-pharmacologic methods for managing symptoms at the end of life
  • Confidently manage the spiritual, emotional and continuing care needs of patients receiving palliative care.


  1. General Medical Council. Treatment and care towards the end of life: good practice in decision making. Updated March 2022. Manchester, UK, 2010.
  2. Cosgrove J, Baruah R, Bassford C, Blackwood D, Pattison N, White C. Care at the end of life: A guide to best practice, discussion and decision-making in and around critical care. Executive Summary. London: Faculty of Intensive Care Medicine, 2019.
  3. McNamara R. Emergency palliative care. Emerg Med J. 2020 May;37(5):260-261.
  4. Royal College of Physicians, Society for Acute Medicine. Acute care resource. End-of-life care in the acute care setting. London, 2021.
  5. Loffredo AJ, Chan GK, Wang DH, Goett R, Isaacs ED, Pearl R, et al. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Annals of emergency medicine 2021;78(5):658-69.
  6. Gomes B, Higginson IJ, Calanzani N, Cohen J, Deliens L, Daveson BA, et al. Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Annals of Oncology 2012;23(8):2006-15.
  7. McKeown K, Haase T, Pratschke J, Twomey S, Donovan H, Engling F. Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study. BMC Palliat Care 2015;14:11.
  8. Office for National Statistics. Deaths registered in England and Wales (Series DR): 2014. Table 12: Deaths registered by age, sex and selected underlying cause of death. Newport, UK: Office for National Statistics; 2015. [Accessed 27 October 2022].
  9. Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. Jama 2003;289(18):2387-92.
  10. Vince S, Lightbody C. The RCEM End of Life Care Toolkit. London, 2020.
  11. Lunney JR, Lynn J, Hogan C. Profiles of older medicare decedents. Journal of the American Geriatrics Society 2002;50(6):1108-12.
  12. World Health Organization. Palliative Care. Geneva, Switzerland: World Health Organization; 2020. [Accessed 27 October 2022].
  13. National Institute for Health and Care Excellence. Care of dying adults in the last days of life. NICE guideline [NG31]. London, UK, 2015.
  14. University Of Edinburgh. Supportive and Palliative Care Indicators Tool.  [Accessed October 27 2022].
  15. Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NK. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 2017;189(13):E484-e93.
  16. British Geriatrics Society. End of Life Care in Frailty: Identification and prognostication, 2020. [Accessed 27 October 2022].
  17. Bailey S-J, Cogle K. Talking about dying: How to begin honest conversations about what lies ahead. London: Royal College of Physicians, 2018.
  18. Dawood M. End of life care in the emergency department. Emergency medicine journal : EMJ 2020;37(5):273-78.
  19. National Institute for Health and Care Excellence. Care and support of people growing older with learning disabilities. NICE guideline [NG96]. London, UK, 2018.
  20. Byw Nawr. Jargon Buster, 2016. [Accessed  27 October 2022]
  21. NHS England, Dementia Team and End of Life Care Team. My future wishes. Advance Care Planning (ACP) for people with dementia in all care settings. Redditch, UK, 2018.
  22. NHS Blood and Transplant. Organ donation laws. [Accessed 27 October 2022].
  23. Tarberg AS, Thronaes M, Landstad BJ, Kvangarsnes M, Hole T. Physicians’ perceptions of patient participation and the involvement of family caregivers in the palliative care pathway. Health expectations : an international journal of public participation in health care and health policy 2022;25(4):1945-53.
  24. Department of Health, Equality and Human Rights Group. Religion or belief. A practical guide for the NHS London, UK: Department of Health; 2009.
  25. Goett R, Isaacs E, Chan GK, Wang D, Aberger K, Pearl R, et al. Quality Measures for Palliative Care in the Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2022
  26. Harvey D, Butler J, Groves J, Manara A, Menon D, Thomas E, et al. Management of perceived devastating brain injury after hospital admission: a consensus statement from stakeholder professional organizations. British journal of anaesthesia 2018;120(1):138-45.

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