Clinical checklists, tick boxes, and other aides memoire in end-of-life care in out-of-hours general practice

Although the 2015 NICE guidelines ‘supplement the individual clinical judgement that is needed to make decisions about the level of certainty of prognosis and how to manage any uncertainty’,¹ the difficulties and uncertainties described by Dr Knights² still exist in out-of-hours (OOH) palliative care in the community or general practice setting. Guidance from pathways or protocols can provide a helpful framework for the home healthcare team, including the visiting OOH GP, who may well not know the patient. Insufficient care and treatment in the absence of clear protocols may, as Dr Knights points out, be a more likely outcome than inappropriate treatment in their presence. A typical GP consultation is undertaken to understand and agree with the patient or relatives what condition management and outcomes can be achieved. Not all boxes need ticking. Relevant ones need to be considered, managed, and reviewed, with a ‘safety net’ that takes into account the variability and uncertainties of health, conditions, and people. In his final section on the case for ‘tick box’ end-of-life care, Dr Knights makes his points well regarding such care in hospital, and the valuable practical assistance to all that accepted protocols or checklists can give. Their absence may make it more difficult to implement NICE guidelines consistently. We feel that his concerns are at least equally applicable in OOH GP work.