Individualised approach needed in end of life care

DOCTORS should avoid taking a “blanket” approach when providing end of life care.

The need to offer more personalised care is the focus of new guidelines from NICE.

Care of dying adults in the last days of life emphasises the need for good communication between healthcare professionals, the patient and those close to them. It also underlines the importance of regular patient reviews and advises “the person should always be taken as an individual.”

The new guidelines replace the Liverpool Care Pathway which was withdrawn amid criticism over failings in the way it was implemented.

Among the issues highlighted with the LCP was the lack of reliable ways of determining whether a person was in the last days of life; drinking water and essential medicines may have been withheld or withdrawn; and in some cases treatment was carried out without forewarning.

The new NICE guidance aims to “put the dying person at the heart of decisions about their care”.

It offers clearer advice on recognising when a person might be near death, which can vary from patient to patient. Doctors should assess for changes in certain signs and symptoms including agitation, deterioration in level of consciousness and increasing fatigue and loss of appetite. Improvements can occur, it adds, and patients should be monitored at least every 24 hours and their care plan updated accordingly.

Good communication is crucial and NICE advises that the dying person and their loved ones should be given accurate information about their prognosis as well as the opportunity to talk through fears and anxieties. A named lead healthcare professional should be made responsible for each patient’s care.

Dying patients who want to drink should be supported to do so, but doctors should explain the impact this may have on their condition.

Professor Sam Ahmedzai, emeritus professor of palliative medicine and chair of the guideline development group, said: “Until now we have never had guidelines in this country on how to look after people at the end of life. This evidence-based guideline provides a good overview of how to give good end of life care in any setting in the NHS.

He added: “The main way this guideline differs to the LCP is that it stresses an individualised approach rather than a ‘blanket’ method of using the LCP in an unthinking way. The guideline also stresses that the patient should be reviewed daily, and the person should always be taken as an individual.”

Access the guidelines on the NICE website.

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