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Withdrawal of dialysis was the second most common cause of death recorded for renal replacement therapy (RRT) in Scotland in 2017; 23% of all deaths.1 In those ≥75 years, this rises to 28%; withdrawal and cardiovascular disease the equal primary causes.1 With an ageing population and more older patients on RRT, considerations around dialysis withdrawal are of increasing importance.1 There is a mean survival of 7.4 (range, 0–40) days once dialysis is withdrawn.2 Successful advanced care planning (ACP) improves end-of-life care (EOLC), the likelihood of dying in their preferred place of death (PPOD) and reduces psychological impact on the surviving carers.3 The degree to which ACP is initiated in this population is unknown which prompted this work. We did a retrospective analysis of adults receiving dialysis for end-stage renal disease. They were identified by the electronic patient record (EPR) (Strathclyde Electronic Renal Patient Record (SERPR), Vitalpulse, UK) in combination with the Greater Glasgow and Clyde electronic records (GGCER). Using SERPR, we identified deaths after dialysis withdrawal over 19 months (2015–2017). All data were anonymised. …

Introduction: The Liverpool care pathway (LCP) was created to aid in the delivery of high-quality palliative care across myriad healthcare providers. After high-profile criticism of the pathway and a subsequent inquiry its use was suspended in the United Kingdom.Objective: The aim of this article is to systematically summarize the conditions leading to the rise and fall of the pathway. The authors also summarize the latest trials, which may point to a beneficial role of the pathway across diverse international settings.Methods: We comprehensively search PubMed, Embase, and Cochrane databases for articles on the use of the LCP from 1997 to present. Keywords ‘LCP,’ ‘Liverpool care pathway,’ and ‘palliative care pathway’ were used. Reference lists of included articles were also assessed for relevant articles.Results: There are two systematic reviews to date with no papers meeting criteria for inclusion. Several studies reported improvements in nausea and breathlessness when using the LCP. One comparative stu...

Background: Healthcare professionals find breaking bad news difficult and upsetting. Increasing cultural diversity has led to a greater number of patients whose first language differs to that of the healthcare provider, with more patients requiring a translator to facilitate communication. Hospitals often ask non-clinical translators to facilitate breaking bad news. We sought to explore the experiences of translators within a specialist oncology centre. Methods: Following ethical and governance approvals, semi-structured interviews were undertaken with five translators recruited from the specialist oncology centre. Interviews were audiotaped and transcribed verbatim. The data were analysed thematically, with major themes and subthemes identified. Setting: Outpatient setting of a regional cancer centre. Participants: Translators serving a regional cancer centre. Main outcome measures: Qualitative data identified through thematic analysis. Results: Major themes included the significant emotional impact of translating distressing information, the challenges of accurately conveying information in a culturally congruent format and the need for formal briefing, debriefing and support. Subthemes included feeling guilty for divulging distressing news, being the focus of patients’ distress or anger, and feeling in conflict with the patient or family and issues surrounding confidentiality. Translators also felt a strong sense of advocacy for the patients and found encounters with death and dying emotionally challenging. Conclusions: The increasing use of translators in the care of patients with advanced cancer is increasingly resulting in lay people being subject to similar emotional pressures faced by clinical staff, yet without the necessary formal training or support mechanisms that are recommended for clinicians. This exploratory study highlights the training and support needs of non-clinical staff as identifying a unique set of communication challenges faced by translators.