No abstract

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No abstract

Integrated care pathway for the last days of life Sir -I agree with Miranido and colleagues that an integrated care pathway (ICP) for the care of dying patients has the potential to extenid hospice car-e of dying in an acute hospital setting.1 Though care pathways started for canicer patienits, the current study and simnilar audit at Kettering General Hospital (unpublished report) demnonstrate increased awareness of the care of patients dyin-g from non-cancer illnesses. However, the study highlights two issues: methodology of studies looking at the etTectiveness of ICP and liimitation-s of the ICP.It is unclear if the patienit groups in baseline and postinmplementation (of ICP) audits were identical.' Authors do not describe how they retrospectively identified 50 people who "had been expected to die' for baseline audit.

Despite the lack of clear benefits of feeding via gastrostomy tube in dementia patients, its use has been increasing. The views of health professionals, patients and their carers differ widely about the perceived benefits, which makes decision-making difficult and stressful. The palliative care approach of facilitating better communication and end-of life care planning can help avoid inappropriate gastrostomy tube placements. A case of an elderly male with dementia and two malignancies is described, and the place of the palliative care approach is explored.