Mrs Jane Stephens1, Ruth Ikobe1, Dr Karen Cooper1, Prof Liz Reymond1
1Brisbane South Palliative Care Collaborative, Eight Mile Plains, Australia
Biography:
Jane has been a registered nurse for 28 years working in various settings including acute, community, primary health, and research. The last 18 years she has specialised in palliative care. Her major interest is ensuring people have dignity and choice at end-of-life and that patients and their families who wish to remain at home receive quality care and support. Jane currently works for caring@home contributing her specialist knowledge to the development and provision of nationally consistent, practical, and evidence-based clinical resources, and educating health professionals to improve experiences for patients and their families in the community.
Abstract:
Background:
When death at home is preferred, proactive planning and caring is essential. As primary care teams increasingly manage end-of-life care with limited specialist input, community nurses—whose roles span diverse care needs—require structured support. Without clear prompts, key planning steps may be missed, leading to unwanted hospital admissions and unmet patient wishes.
Aims:
caring@home aimed to develop a simple, evidence-based checklist to support community nurses in proactively planning for a home death.
Methods:
Internet and database searches found no existing checklists to support community nurses in planning for a home death. Community nursing services providing palliative care were consulted and confirmed that a resource to support this planning would be a valuable resource to enrich practice. A multidisciplinary working group developed an evidence-based checklist, which was reviewed by specialist and community nurses across multiple services. Feedback was incorporated to refine the checklist, improving its relevance and value in guiding consistent, proactive end-of-life planning.
Results:
The terminal care planning checklist for nurses in the community outlines key actions to plan care for a person in their final hours, days or week of life. It aligns with the terminal care phase of the Prompts for End-of-Life Planning (PELP) framework. Designed as an iterative tool, the checklist allows multiple nurses to contribute across care episodes. It has been well received nationally, receiving over 120 views per month with a strong download rate of 67% confirming its value in supporting quality end-of-life care at home.
Conclusion:
The Terminal Care Planning Checklist supports community nurses to proactively plan for end-of-life care at home. Through the identification of key planning actions, it may help reduce unwanted hospital admissions and increase the likelihood of home deaths being realised, aligning care with patient preferences and improving coordination across nursing teams.