End-of-life care guidance offers clarity for nurses

The guidance from the General Medical Council follows a Nursing Times survey that found one in ten nurses admitted restricting pain relief for dying patients for fear of prosecution for assisted suicide.

The poll of more than 2,000 nurses also revealed some felt doctors deliberately under-prescribed pain medication for fear of prosecution themselves.

The GMC guidance places an onus on doctors to plan end of life care and listen to patients’ wishes about treatment, including palliative care.

It also says doctors have a duty to consult other healthcare professionals like nurses, communicate effectively with other team members, and seek second opinions from experienced staff such as nurses when unsure about treatment options.

Claire Henry, programme director of the NHS National End of Life Care Programme, said the guidance should mean greater clarity for nurses worried about complex issues like pain relief.

“I think it will really help with that,” she said. “The key thing is that it gets people to talk about it and it really emphasises the multi-disciplinary team in all of it, which is fantastic.”

Susan Munroe, director of nursing and patient services at Marie Curie Cancer Care, said better communication from doctors would be helpful.

But she added: “Communication is a two-way street and a nurse who has any doubts about what a doctor has prescribed must take that up with the doctor.”

She welcomed the new guidance: “It’s great because doctors are being encouraged to have these difficult conversations with patients around end of life and it’s a tool nurses can use to help doctors have those conversations.”

Mike Hobday, head of policy at Macmillan Cancer Support, added: “The reality is a lot of doctors don’t like having those conversations whereas nurses don’t have the option to duck them.”

He said the emphasis on planning ahead and listening to patients’ wishes would inevitably lead to more demand for nursing care.

“Doctors talking to patients is the first step,” he said. “It should open up conversations between doctors [about] the panoply of nursing and other support that’s available to patients.”

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