Initiating end-of-life care

End-of-life (EOL) care is an integral component of healthcare delivery, ensuring patients with terminal or advanced chronic conditions receive appropriate, compassionate and patient-centred support. As patients approach the terminal phase of illness, their clinical and personal needs evolve significantly. Initiating timely and appropriate EOL care ensures treatment aligns with patient preferences and values while minimising unnecessary interventions.

How do we recognise when to initiate EOL care, communicating effectively with patients and families and deliver holistic care within interdisciplinary teams?

EOL care may begin as early as 12 months prior to death, with key clinical indicators including:

• Functional and cognitive decline
• Increased frequency of unplanned hospital admissions
• Escalating symptom burden
• Weight loss, frailty and reduced oral intake
• Shift from curative to palliative treatment goals

These markers, when observed, should prompt clinicians and healthcare staff to review care goals and initiate conversations around EOL planning (NHS, n.d.; RACGP, n.d.; ACSQHC, 2020).

Effective communication is central to successful EOL care. Balaban (2000) recommends a structured approach involving:

• Assessment of patient and family understanding
• Delivery of information with clarity and empathy – sharing prognosis sensitively
• Exploration of values, priorities, and care goals
• Encouraging shared decision-making

Lee (2002) highlights that these discussions should be tailored to the patient’s readiness and documented clearly in the care plan.

As Liegner (1975) emphasised, high-quality EOL care transcends symptom control. It encompasses:

• Emotional support: Listening, validating emotions, and reassurance
• Spiritual and cultural care: Respecting beliefs, values, and rituals
• Environmental considerations: Providing peaceful, dignified settings
• Therapeutic presence: Maintaining continuity and empathy in care

EOL care for Aboriginal and Torres Strait Islander patients necessitates a culturally sensitive approach that honours their unique traditions, beliefs, and values. The “Dying to Yarn” symposium, held in Brisbane in 2019, highlighted the importance of open discussions about death and dying within Indigenous communities to enhance palliative care outcomes. Queensland Health’s Aboriginal and Torres Strait Islander Hospital Liaison Officers act as a cultural link between health professionals, Aboriginal and Torres Strait Islander patients and their families.

Successful EOL care depends on coordinated efforts across disciplines. Best practices include:

• Multidisciplinary meetings and care planning
• Utilisation of standardised care pathways and advance care plans
• Clear and consistent documentation of decisions and preferences

These measures support continuity, reduce care fragmentation, and align with patient wishes (Lee, 2002; Liegner, 1975).

End-of-life (EOL) care does not end at the time of death. The period immediately following a patient’s death is a crucial time for demonstrating respect, cultural sensitivity, and providing ongoing support to families. After-death care is a core component of holistic and dignified EOL care. Kübler-Ross (1969) introduced the five stages of grief—denial, anger, bargaining, depression and acceptance—as a psychological framework for understanding how patients and families cope with terminal illness. For Aboriginal and Torres Strait Islander patients, practices such as “Sorry Business,” which encompasses mourning rituals and communal grieving, play a crucial role in the bereavement process. Healthcare professionals should collaborate with local communities to understand and respect these practices, ensuring that care plans are comprehensive and culturally appropriate.

In conclusion, initiating EOL care is a critical professional responsibility that combines clinical acumen, ethical practice, and compassionate communication. It is not a one-time conversation but a dynamic, evolving process. By recognising the right time to act and engaging with patients and families meaningfully, healthcare professionals can improve the end-of-life experience, delivering care that is respectful, person-centred and dignified.

Australian Commission on Safety and Quality in Health Care. (2020). End-of-life care: Last days of life. https://www.safetyandquality.gov.au/sites/default/files/2020-11/end-of-life_care_-_last_days_of_life.pdf

Balaban, R. B. (2000). A physician’s guide to talking about end-of-life care. Journal of General Internal Medicine, 15(3), 195–200. https://doi.org/10.1046/j.1525-1497.2000.07228.x

Kübler-Ross, E. (1969). On death and dying. New York, NY: Macmillan Publishing Company.

Lee, D. H. (2002). Approach to end of life care. Ochsner Journal, 4(2), 98–103.

                    Liegner, L. M. (1975). Care of the dying patient. JAMA, 234(10), 1047–1048.

National Health Service. (n.d.). What end of life care involves and when it starts. https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-starts/

Palliative Care Australia. (2018, August 21). Palliative care – Aboriginal and Torres Strait Islander [Video]. YouTube. https://www.youtube.com/watch?v=D9jKF8nTCQ8

Palliative Care Australia. (2019, December 10). Palliative Matters: Dying to Yarn breaks down barriers. Retrieved April 5, 2025, from https://palliativecare.org.au/story/palliative-matters-dying-to-yarn-breaks-down-barriers/

Royal Australian College of General Practitioners. (n.d.). Palliative care – Silver Book Part A. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/palliative-care