New guidelines on end of life care published by NICE

"NICE urges doctors to treat dying patients as individuals," BBC News reports. The headline is prompted by the publication of new guidelines from the National Institute for Health and Care Excellence (NICE) on end of life care.

The guidelines are designed to replace the controversial Liverpool Care Pathway, which was phased out in 2014.

 

The Liverpool Care Pathway (LCP) was developed during the late 1990s at the Royal Liverpool University Hospital, in conjunction with the Marie Curie Palliative Care Institute. It was intended to provide the best possible quality of care for dying patients in the last hours and days of life, whether they were in hospital, at home, in a care home or in a hospice.

Most palliative care experts felt that if carried out properly, by trained staff, the LCP could help ensure death is as dignified and as peaceful as possible.

recent independent report ranked the standard of end of life care in the UK as the best in the world. Still, concerns were raised in the media that, in some cases, the LCP was not being correctly followed, allegedly leading to unnecessary suffering in patients and emotional trauma to family and friends.

As NICE highlights in its new guidelines, there were three main areas of concern:

 

The main recommendations of the new guidelines are outlined below – for a complete list visit the NICE website.

If someone is dying, they should be checked every day for symptoms and changes that might show they are close to death, and also for signs they are not getting any worse or might be improving.

If someone is likely to die very soon, this should be explained to them by a member of their care team honestly and in as much or as little detail as they want. They should be able to have the people important to them with them when they have this discussion, if they wish.

It is important that people are involved in decisions about their care in the last days of their life, if that is what they want, and that their wishes are respected.

Their doctor or another member of the care team should talk to the person who is dying about the care and support they would like and, if the person agrees, involve their family members or other people important to them in these discussions. This might include particular treatments or identifying who should make decisions for them if they are no longer able.

Sometimes decisions are already included in an "advance statement", which has details about the care a person would like at the end of their life and what is important to them.

The following symptoms should be checked for and managed appropriately:

The doctor should consider:

Medicines are sometimes prescribed in advance for symptoms that might happen in the future. These medicines are often called "just in case" medicines and may be provided in a specially marked container called a "just in case" box.

Providing medicines in advance means there's no delay in getting medicines that might be needed quickly to help with symptoms. This may be particularly important for people who are not in hospital.

Before "just in case" medicine is given, checks should be carried out to ensure the medicine is still the right type for the person's symptoms. After they are taken, checks should be carried out at least once a day to see if their symptoms are improving or if there are any side effects.

For more information on treatment options, visit the NHS Choices End of Life Care Guide

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