From the Research
The UK NICE guidelines for end-of-life care prioritize providing compassionate, personalized care for people in their final days of life, focusing on symptom management, hydration, and psychological support, as recommended in the most recent and highest quality study 1.
Key Recommendations
- Identifying when a person may be entering their last days and communicating sensitively with the dying person and their loved ones
- Maintaining hydration through assisted drinking if possible and considering clinically assisted hydration if appropriate
- Prescribing medications in advance for symptom management, including:
- Morphine (starting at 2.5-5mg every 4 hours as needed) for pain and breathlessness
- Midazolam (2.5-5mg subcutaneously as needed) for anxiety
- Levomepromazine (6.25-12.5mg subcutaneously as needed) for nausea and vomiting
- Hyoscine butylbromide (20mg subcutaneously as needed) for respiratory secretions
- Regularly assessing comfort, reviewing medications daily, and stopping unnecessary treatments
- Supporting psychological, social, and spiritual needs while respecting cultural preferences
- Continuing care after death, providing support to bereaved family members and ensuring dignified handling of the deceased's body according to their wishes and cultural practices
Rationale
The guidelines emphasize the importance of individualized care planning for the dying patient, as highlighted in the publication of the guidance: One Chance to Get It Right 1. This approach requires healthcare professionals to provide compassionate and personalized care, taking into account the unique needs and preferences of each patient. The use of medications such as morphine, midazolam, and levomepromazine is supported by strong evidence for symptom management 2. Additionally, the guidelines recognize the importance of supporting psychological, social, and spiritual needs, as well as respecting cultural preferences 3.