Withdrawal in Palliative Care

The goal of withdrawing treatment is to allow the natural process of death to proceed instead of prolonging the dying process with treatments that may offer little benefit (and potentially high burdens) to the patient. This then leads to day-to-day deterioration, particularly of strength, appetite, and awareness, and can unfold gradually over days or weeks, or occur precipitously following an unexpected event, e.g. stroke.

This content collection outlines different types of treatment withdrawal that can occur in palliative care and what proactive steps can be done to allow for better quality of life for the patient as well as the family.

Chapters free until April 30th 2020

The Seventh Domain of Palliative Care: Care of the Patient at the End of Life
from Palliative Psychology: Clinical Perspectives on an Emerging Specialty


This chapter outlines the care required for a patient who is dying and what support can be offered to the family.

Care of the dying person
from Oxford Textbook of Medicine Sixth Edition 


The care a patient receives in the last hours to days of life has a significant impact on their quality of life and death.


This chapter discusses seven core components that are required in order to provide high-quality care for the dying patient.


Discontinuation of Life-Sustaining Therapies
from Clinical Pocket Guide to Advanced Practice Palliative Nursing


This chapter discuss the withdrawing and withholding of life-sustaining treatment such as antibiotics, blood products, dialysis, and artificial nutrition, in critically and terminally ill patients. 


Withdrawal of Cardiology Technology
from Advanced Practice Palliative Nursing


For patients with advanced heart failure, early intervention that collaborates cardiology and palliative care will optimize patient care and well-being.


This chapter explains the process of withdrawing cardiac treatment and how to keep the patient comfortable. 


Withdrawal of Invasive Mechanical Ventilation
from Oxford Textbook of Palliative Nursing Fifth Edition


Mechanical ventilation has been used for decades to support breathing when patients experienced acute or chronic respiratory failure. This chapter discusses the benefits and burdens of mechanical ventilation and how to prepare for withdrawal. 

Dialysis withdrawal and palliative care
from Oxford Textbook of Clinical Nephrology (4 ed.) 


This chapter outlines why dialysis withdrawal is so common in the United States, when dialysis withdrawal and withholding is appropriate, and the role of palliative care in the renal patient.

The terminal phase
from Oxford Handbook of Palliative Care Third Edition


This chapter discusses end-of-life care and what principles should be upheld to allow for a ‘good death’. 

Clinical Signs of Impending Death in Cancer Patients
from 50 Studies Every Palliative Care Doctor Should Know


How often and when do patients with advanced cancer develop physical signs of impending death, and what is their diagnostic accuracy? Find out here

Care of the Family
from Surgical Palliative Care


When caring for the critically ill, most interactions and conversations will not be with the patients but with their families.  


This chapter discusses how caring for the family is a necessary and essential part of taking care of the patient. 

The Ethos of Palliative Nursing
By Mark Lazenby and Michael Anthony Moore


Read this edited extract from the full chapter ‘The Ethos of Palliative Nursing’ from the Oxford Textbook of Palliative Nursing, Fifth Edition (OUP, 2019). 

Advance care planning: definitions and recommendations for its use
By Judith Rietjens and Ida Korfage 


This article is a report following Judith Rietjens and Ida Korfage’s white paper ‘Definition and recommendations for advance care planning: An international consensus’ published in The Lancet Oncology in September 2017.

Research in palliative care 
By Max Watson, Stephen Ward, Nandini Vallath, Jo Wells, and Rachel Campbell 


Some people feel that palliative care research in dying patients is not appropriate. This article discusses the difficulties encountered in conducting palliative care studies as well as its importance. 


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