Care of Dying Adults in the Last Days of Life

Excerpt

This guideline applies to dying people aged 18 or older. It is acknowledged that a parallel guideline is being developed by NICE to cover the end of life care for infants, children and young people.

This guideline covers recognising dying, communication and shared decision-making and only the clinical aspects of symptom management. We have not made recommendations about how services should be configured to deliver these aspects of care. An update of the 2004 guidance on Supportive and Palliative Care for Adults with Cancer will be started in 2016, and this will not only cover the service delivery aspects of the current guideline, but will also extend beyond the cancer focus.

Contents

• Guideline Committee members
• 1. Guideline summary
  • 1.1. Full list of recommendations
  • 1.2. Key research recommendation
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is a NICE clinical guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Evidence of cost effectiveness
  • 4.4. Developing recommendations
• 5. Recognising when a person may be in the last days of life
  • 5.1. Introduction
  • 5.2. Review question: What signs and symptoms indicate that adults are likely to be entering their final days of life; or that they may be recovering? How are uncertainties about either situation dealt with?
  • 5.3. Quantitative review: clinical evidence
  • 5.4. Qualitative review: clinical evidence
  • 5.5. Economic evidence
  • 5.6. Evidence statements
  • 5.7. Conceptual framework
  • 5.8. Recommendations and link to evidence
  • 5.9. Research recommendation
• 6. Communication
  • 6.1. Introduction
  • 6.2. Review question: What are the barriers and facilitators to good communication between the dying person, those important to them and the healthcare professional surrounding the likelihood of entering the last days of life?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Shared decision making
  • 7.1. Introduction
  • 7.2. Review question: What are the facilitators and barriers to the multi-professional team, dying person and those important to them in being involved in shared decision-making to inform the development of personalised care plans for the last few days of life?
  • 7.3. Clinical evidence
  • 7.4. Economic evidence
  • 7.5. Evidence statements
  • 7.6. Recommendations and link to evidence
• 8. Maintaining hydration
  • 8.1. Introduction
  • 8.2. Review question: In patients in their last days of life, is clinically assisted hydration effective in improving symptoms and general comfort?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Pharmacological interventions
  • 9.1. Review question: For people in the last days of life, which pharmacological agents are most effective in relieving pain, breathlessness, nausea and vomiting, anxiety, agitation, delirium and noisy respiratory secretions and what degree of sedation do they cause?
  • Managing pain
  • Managing breathlessness
  • Managing nausea and vomiting
  • Managing anxiety
  • Managing delirium
  • Managing agitation
  • Managing noisy respiratory secretions
  • General pharmacological considerations
• 10. Anticipatory prescribing
  • 10.1. Introduction
  • 10.2. Review question – quantitative: How effective is anticipatory prescribing at improving comfort in adults in the last days of life compared with prescribing at the bed side?
  • 10.3. Review question – qualitative: What are the experiences, opinions and attitudes of healthcare professionals, the dying person and those important to them regarding access to anticipatory prescribing?
  • 10.4. Clinical evidence – quantitative
  • 10.5. Clinical evidence – qualitative
  • 10.6. Economic evidence
  • 10.7. Evidence Statements
  • 10.8. Recommendations and link to evidence
  • 10.9. Research recommendations
• 11. Acronyms and abbreviations
• 12. Glossary
• 13. References
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Economic review protocol
  • Appendix E. Clinical article selection
  • Appendix F. Economic article selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • Appendix I. Economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots
  • Appendix L. Excluded clinical studies
  • Appendix M. Excluded economic studies
  • Appendix N. Unit Costs
  • Appendix O. Research recommendations
  • Appendix P. NICE technical team
  • Appendix Q. References

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.