Access to symptom management

The Scottish Palliative Care Guidelines provide comprehensive treatment guidelines for a wide variety of symptoms and palliative emergencies. The full guidelines can be accessed here: Scottish Palliative Care Guidelines | Right Decisions.

These include but are not limited to:

Symptom control

• Anorexia/cachexia
• Breathlessness
• Cough
• Pain

Palliative Emergencies

• Hypercalcaemia
• Malignant Spinal cord compression
• Superior vena cava obstruction
• Catastrophic bleeding (haemoptysis)

For anyone anticipated to be in their last weeks of life whose preference is for home-based care, please refer to the Scottish palliative Care Guidelines End of Life Care section which covers a wide range of considerations including guidance on DNACPR and anticipatory medications.

Compliance Aids

Before any recommendation is made to a patient or their family around the use of a medicine compliance aid (such as a plus-pak, dosette box etc) a full needs assessment should be undertaken in line with any local Health Board policy or guidance. It should be noted that evidence is limited on the benefit of using such aids, and there are many potential disadvantages of recommending this route for a patient who may be near the end of their life or whose medications and symptom control may be subject to regular change, titration or discontinuation. Access to compliance aid dispensing may vary across the country and often the responsibility to source a supplier will fall to the patient or their families/carers.  Some medicines cannot be incorporated into compliance aids due to their legal status or due to the individual medicine instability outwith the original packaging. ‘PRN’ or ‘as required’ medicines cannot be included in a compliance aid for obvious reasons. Dispensing in compliance aids may significantly delay prescription turnaround times, timely access to medicines and discharge arrangements.