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Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a ?Deathbed Etiquette? guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words ?death? and ?dying? were identified. Most participants also expressed reservations about the title, with the word ?deathbed? found to be old-fashioned and the word ?etiquette? not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for ?mythbusting? death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The ?Deathbed Etiquette? guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.

Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a ?Deathbed Etiquette? guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words ?death? and ?dying? were identified. Most participants also expressed reservations about the title, with the word ?deathbed? found to be old-fashioned and the word ?etiquette? not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for ?mythbusting? death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The ?Deathbed Etiquette? guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.

Background Heart failure is a serious life limiting condition and patients can have a high symptom burden, reduced quality of life and increased unscheduled hospital admissions. Despite guidance advocating a palliative care approach in advanced heart failure, the variable disease trajectory leads to difficulty in predicting prognosis, which acts as a barrier to considering palliative care for these patients.Aims This systematic review explores which clinically relevant variables are associated with a poor prognosis in heart failure and examines if it is possible to determine which of these variables best predict mortality.Method Databases including conference abstracts and grey literature were searched using pre-defined terms. Screening of title and abstract, followed by full text review against inclusion criteria. Two reviewers extracted data from included studies and assessed Hayden risk of bias. Findings were subjected to narrative synthesis as meta-analysis was not possible.Results 29306 records were screened resulting in 37 included studies. There was a plethora of prognostic variables studied, including demographic, laboratory, electrocardiography, echocardiogram and clinical variables as well as studies that developed models from multiple variables. The primary variables were often only studied once, but even for the few that were investigated more than once, were adjusted for by different covariates and so could not be combined.Conclusions This systematic review failed to find clinically useful prognostic variables to identify patients in the last year of life. Although we identified a variety of proposed prognostic variables, these were explored in a single or in only a few studies, often in restricted populations meaning they cannot be generalised. Identifying good predictors of this phase of life is useful to facilitate advance care planning. Future prognostication research should concentrate on variables measured over time and studying real life populati