title: Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care.
abstract: OBJECTIVE
  Terminal haemorrhage is a rare and distressing emergency in palliative oncology. We present an algorithm for the management of terminal haemorrhage in patients likely to receive end-of-life care at home, based on a literature review of the management of terminal haemorrhage for patients with advanced cancer, where a DNAR (do not attempt resuscitation) order is in place and the patient wishes to die at home.
  
  
  METHODS
  A literature review was conducted to identify literature on the management of terminal haemorrhage in patients with advanced cancer who are no longer amenable to active interventional/invasive procedures. Electronic databases, the grey literature, local guidelines from hospitals and hospices, and online web portals were all searched systematically. The literature review was used to formulate a management algorithm.
  
  
  RESULTS
  The evidence base is very limited. A three-step practical algorithm is suggested: preparing for the event, managing the event ('ABC') and 'aftercare'. Step 1 involves the identification and optimisation of risk factors. Step 2 (the event) consists of A (assure and re-assure the patient), B (be there - above all stay with the patient) and C (comfort, calm, consider dark towels and anxiolytics if possible). Step 3 (the aftercare) involves the provision of practical and psychological support to those involved including relatives and professionals.
  
  
  CONCLUSIONS
  Terminal haemorrhage is a rare yet highly feared complication of advanced cancer, for which there is a limited evidence base to guide management. The suggested three-step approach to managing this situation gives professionals a logical framework within which to work.
authors.affiliation: St Raphael's Hospice, Cheam, Sutton, Surrey.
authors.forename: Edith
authors.initials: E
authors.lastname: Ubogagu
authors.forename: Dylan G
authors.initials: DG
authors.lastname: Harris
mesh_terms: D019468:Disease Management; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D016414:Resuscitation Orders; D013727:Terminal Care / Q000379:methods*; D006113:United Kingdom