End of life care for adults: service delivery – NICE Guidelines

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This guideline, developed by the National Guideline Centre (NGC) and hosted by the Royal College of Physicians (RCP), covers organising and delivering end of life care services. It aims to ensure that people have access to the care that they want and need in all care settings. It also includes advice on services for carers.

End of life care is defined by NHS England as care that is provided in the 'last year of life'; although for some conditions, end of life care may be provided for months or years. After the Liverpool Care Pathway was withdrawn in 2014, a number of national reports, guidelines and policy documents began to describe the changes needed for a new approach to end of life care services. They identified that high-quality, timely, compassionate personalised care and support planning, including advance care planning, should be accessible to all those who need it. To progress this intention, the models of care and the service delivery arrangements that need to be put in place for people as they approach the end of their life have been defined in this guidance.

End of life care may be delivered by disease-specific specialists and their associated teams; by generalists such as primary care teams or hospital-based generalists (for example, elderly care); or by palliative care specialists in hospices, hospitals and community settings. Giving this type of care can ensure that people live well until they die.

End of life care for adults: service delivery, therefore, describes the provision of end of life care services for adults approaching the end of their life with any conditions and diseases. The guideline advises on service models for care in acute settings by disease-specific specialists and their supportive services, and in community settings by primary care or specialists in palliative care (for example, in hospices). It is intended to be used alongside the NICE guideline on care of dying adults in the last days of life, which covers care planning and clinical interventions for people who are considered to be in the last days of life.

Key recommendations

Recommendations in the NICE guideline cover the following areas:

  • Identifying adults who may be approaching the end of their life
  • Holistic needs assessment
  • Supporting carers and providing information
  • Reviewing current treatment
  • Advance care planning and reviewing people’s needs
  • Communication between services, providing multipractitioner care and care coordination
  • Transferring people between care settings and providing out-of-hours care