Implementing the 5 Priorities for End-of-Life Care in Hospitals

One Chance to Get it Right

Applying the 5 Priorities for Care of the Dying Person in Hospital Practice

Improving End-of-Life Care in Hospitals

5 Priorities of Care

Today I will present an overview of the One Chance to Get it Right guidance, developed by the Leadership Alliance in 2014. This framework was introduced to improve care in the last days and hours of life, focusing on individualised, compassionate, and patient-centred care in hospital settings.

Background & Rationale

Introduced after withdrawal of the Liverpool Care Pathway (2014)

Concerns raised: poor communication & 'tick-box' care

Aim: improve quality & consistency of end-of-life care in hospitals

The Liverpool Care Pathway was criticised for being too standardised, sometimes leading to poor communication and distress for families. This document emphasises that care must be individualised and based on the needs of each patient.

The 5 Priorities

Recognise Dying

Communicate Sensitively

Involve Patient & Family

Support Families

Individualised Care Plan

These priorities apply when a person may die within the next few days or hours, and all are equally important in ensuring high-quality care.

Visual Care Pathway

Recognise

Assess

Communicate

Shared Decisions

Care Plan

Review

Continuous review ensures care remains responsive to the patient's changing needs.

This diagram shows that care is not linear but cyclical. Patients must be regularly reassessed, and care plans updated based on changes in condition, needs, and wishes.

Priority 1

Recognising Dying

Clinical judgement — uncertainty must be acknowledged

Continuous assessment as condition changes

Communicate clearly and sensitively with patient & family

Recognising dying is complex and not always precise. The guidance emphasises focusing on deterioration and clinical instability rather than a fixed diagnosis of dying. Importantly, this must be communicated clearly and sensitively.

Priority 2 — Deep Dive

Communication

Honest, clear and sensitive communication at all times

Avoid euphemisms — use plain, direct language

Two-way discussions: listen as much as you speak

Document all conversations thoroughly

Communication is central to all priorities. The report highlights that failure to inform families that a patient was dying caused significant distress. Communication must be proactive, honest, and adapted to patient understanding.

Communication Flow

Prepare

Assess Understanding

Explain Clearly

Respond & Listen

Agree a Plan

Document

Every conversation should be tailored, documented and followed up.

This structured approach ensures communication is clear, compassionate, and consistent across the multidisciplinary team.

Priority 3 & 4

Involvement & Family Support

Shared decision-making — involve patient where possible

Respect and honour individual patient preferences

Support the emotional and practical needs of families

Patients should be involved in decisions as much as they wish, and families should be supported emotionally and practically. Families often experience distress, and their needs must be actively explored.

PRIORITY 5

Individualised Care Plan

Symptom control — pain, breathlessness, agitation

Food & hydration reviewed individually

Psychological, spiritual & religious needs addressed

MDT involvement — nursing, medical, allied health

Care must be tailored to the individual, including symptom control and holistic needs. Importantly, patients should be supported to eat and drink where appropriate, and care plans must be documented and regularly reviewed.

HOSPITAL PRACTICE

Application in Practice

MDT working — coordinated, team-based care

Clear and thorough documentation at every stage

Senior clinician responsibility for care decisions

Early referral to specialist palliative care services

In hospital settings, applying these priorities requires strong multidisciplinary collaboration, clear leadership, and timely involvement of specialist palliative care teams.

Critical Analysis

Patient-centred approach

Flexible and adaptable framework

Promotes dignity in dying

Depends heavily on staff training

Time pressures in acute settings

Significant variation in practice

While the framework promotes high-quality care, its success depends heavily on staff skills, especially communication, and organisational support.

Conclusion

Key Takeaways

Individualised care is at the heart of good dying care

Communication underpins all 5 priorities

Families are essential partners in care

Ongoing review ensures care remains person-centred

"One chance to get it right — every patient deserves it."

The key message is that end-of-life care must focus on the individual, not a protocol. We only have one chance to get it right, and these priorities ensure dignity, compassion, and respect in a patient's final moments.