End-of-life care should focus around individuals

New guidelines from the National Institute for Health and Care Excellence (NICE) have urged doctors to put individuals at the centre of any end-of-life plans that are put in place.

It is estimated that around 500,000 people die each year and 75 per cent of these are expected, non-sudden deaths.

Until recently, the Liverpool Care Pathway (LCP) was used as a way to provide end-of-life care but the scheme was heavily criticised and eventually axed because of fears that it was being misused.

The LCP was replaced by individual care plans, with evidence-based guidelines being created by NICE.  Its new recommendation aims to tackle the problems associated with the previous initiative, such as medication and water being unnecessarily withdrawn.

One of the main issues with the LCP is that it is difficult to establish when a person may be in the last days of their life, as it can be challenging to see whether a person or dying and whether they will deteriorate further. 

In order to make this clearer, the guidelines from NICE recommends doctors look at whether there has been a change in certain signs and symptoms, such as agitation, level of consciousness and fatigue.

Putting the individual at the heart of the new end-of-life care plans, the report says that healthcare professionals need to be aware that any of these warning signs could suggest a person is reaching their final days.

People should be monitored for further changes at least every 24 hours, and the person’s care plan should be updated accordingly, it added.

Annette Furley, a member of the guideline group who provides support both to people nearing the end of their lives and those important to them, said health and social care professionals should be offering the best care whether that is clinical or practical when someone is nearing death.

“People that I and my colleagues have supported all share a desire to die peacefully, without pain, and without unnecessary discomfort, with control and with dignity. I believe that this guideline will help enable people to do that,” Ms Furnley added.

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