End of Life Care Plan (EOLCP) Template

End of Life Care Plan (EOLCP) Patient Identification: Name: John Doe Date of Birth: 15 March 1945 Hospital ID: 123456 Date of Admission: 1 November 2024 Current Clinical Status: John Doe has been diagnosed with advanced metastatic lung cancer. His prognosis is poor, with an estimated life expectancy of less than six months. His medical history includes chronic obstructive pulmonary disease (COPD) and hypertension. Patient Understanding and Wishes: John understands that his condition is terminal and has expressed a desire to focus on comfort and quality of life rather than aggressive treatment. He wishes to avoid invasive procedures and prefers palliative care. Family/Carer Involvement: Discussions have been held with John's wife and daughter. They are supportive of his wishes and are actively involved in decision-making. They understand the prognosis and are prepared to assist in his care. Advance Care Planning: John has a living will and has expressed a Do Not Resuscitate (DNR) order. He has completed a POLST form indicating his preferences for end-of-life care. Symptom Management Plan: John is currently experiencing significant pain and breathlessness. A plan is in place to manage these symptoms with appropriate medications, including opioids for pain and bronchodilators for breathlessness. Psychosocial and Spiritual Needs: John has expressed feelings of anxiety and fear about the dying process. He is receiving support from a psychologist and has requested visits from a chaplain to address his spiritual needs. Place of Care Preferences: John prefers to spend his remaining time at home, surrounded by family. He wishes to avoid hospital admissions unless absolutely necessary. Care Coordination and Support Services: - Dr. Emily Smith, Oncologist - Dr. Sarah Johnson, Palliative Care Specialist - Nurse Jane Brown, Home Care Nurse - Referral to hospice services - Social Worker: Mary Green - Chaplain: Father Michael Legal and Ethical Considerations: There are no current legal concerns or guardianship issues. John has full capacity to make decisions regarding his care. Care Plan Review Arrangements: The care plan will be reviewed every two weeks or sooner if there are significant changes in John's condition. Dr. Sarah Johnson will be responsible for coordinating reviews, with input from the home care team. Clinician Notes: John has shown remarkable resilience and acceptance of his condition. Continued psychological support is recommended to help him and his family cope with the emotional challenges ahead.