16.12.15
End-of-life care must be individualised and interlinked, NICE says
NICE has published new guidelines setting out how healthcare staff can help give people the best and most individualised care at the end of their lives in response to the abolition of the controversial Liverpool Care Pathway.
The Pathway was a protocol introduced in the 1990s for looking after people at the end of their lives, but was phased out last year after a government-commissioned review identified grave failings in how it was being implemented.
Sam Ahmedzai, a professor of palliative medicine and chair of the independent committee of experts who developed the guideline, said: “The Liverpool Care Pathway was originally developed to help the NHS provide ‘a good death’ for people at the end of their lives. However, its implementation became increasingly controversial over the years with stories of fluids and medicines being withheld, over-sedating the dying person.
“There were also problems with inexperienced staff recognising when someone was truly close to death, or if they had a possibility of recovery. It became seen as a ‘tick-box exercise’ and a ‘one-size-fits-all’ approach.”
Ahmedzai said the new NICE guideline addresses these issues and gives professionals a “comprehensive, humane and evidence-based” framework for providing the best possible care based on people’s individual needs and wishes.
The guideline, for clinicians in all areas of the NHS, sets out recommendations for recognising when death is imminent or if the person may be deteriorating, stabilising or improving.
It proposes avoiding tests unlikely to affect care in the last few days of life unless there is a clear clinical need for them, and recommends seeking advice from more experienced colleagues when there is a high level of uncertainty.
As well as reiterating the importance of maintaining people’s hydration, NICE also emphasised the need for shared decision-making and clear communication between all professionals concerned.
These decisions must be steered, it said, by individualised care plans in discussion with the person who is dying and their families, which take into account their own needs and wishes.
While NICE said this must apply across all staff, Susan Dewar, a community district nurse and independent committee member, said listening to the needs of patients and those close to them is an “integral part of nursing”.
“Translating the information gathered leads on to the development of an individualised care plan for that person. Everyone is an individual so the care should be individualised, but supported by the best available evidence, and this is what this guideline supports,” Dewar added.
Although it welcomed the guidance’s “holistic approach” to help doctors, nurses and other professionals, charity Hospice UK said the real challenge will be putting it into practice.
The charity’s chair, Lord Howard of Lympne, said: “There can never be a ‘tick-list approach’ towards caring for the dying, and this guidance must be underpinned by greater investment in training and education for all staff involved in end-of-life care.
“This is crucial if we are to avoid the failings of how the Liverpool Care Pathway as implemented. All staff need to be trained in caring for dying people and their families, and Health Education England urgently needs to take up the gauntlet on this front.
“There also needs to be a deep-seated cultural shift within the NHS, if doctors and nurses are to provide more compassionate, responsive care that is genuinely centred on dying people’s needs.”