Good communication key in end-of-life care

PATIENTS and those close to them should be involved in key decisions about end-of-life care, according to new draft NICE guidance.

Clear communication is crucial to ensuring patients are respected and given excellent care, it says.

The draft guideline, which has been published for consultation, aims to help clinicians recognise when death is imminent as well as offering advice on managing common symptoms, and ensuring patients and their loved ones are "at the heart of decisions about their care."

It follows the abolition of the Liverpool Care Pathway, a protocol for caring for people at the end of their life. This was phased out last year after a government-commissioned review found serious failings in the way it was being implemented in some areas.

The draft guideline makes a number of recommendations. It lists signs and symptoms that may suggest a person is nearing death; and highlights the need for clear communication with the patient and the importance of shared decision making with patients/loved ones.

It goes on to advise on fluid intake for dying patients, adding that they should be encouraged to drink if they want to/are able to. There is also guidance on medication prescribing and how to manage common end-of-life symptoms such as pain, nausea and anxiety. Medicines that are not providing symptomatic benefit should be stopped, it adds.

NICE chief executive Sir Andrew Dillon said: "Earlier this year, the Parliamentary and Health Service Ombudsman said that end of life care could be improved for up to 335,000 people every year in England. The guideline we are developing will ensure that people who are nearing the end of their lives are treated with respect and receive excellent care."

The consultation runs until September 9, 2015, after which time a final guideline will be published.