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Ask about wishes and spiritual beliefs in final days, says NICE

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Patients near the end of their lives should be asked about their wishes and any spiritual beliefs, according to care standards published by the National Institute for Health and Care Excellence.

Adults in the last days of life, and the people important to them, should be given opportunities to discuss the care they want to receive, stated NICE, as part of efforts to improve patient choice.

“Our guidance will support doctors, nurses and other healthcare professionals”

Gillian Leng

This should include asking the patient where they want to be cared for and if they have any cultural, religious or social preferences that need to be taken into account.

NICE has published a new quality standard intended to improve the care given to people in their final days of life.

It noted the 2016 End of Life Care Audit had found nearly half of all deaths in England occurred in hospital, and spiritual wishes were only recorded for one in seven able to communicate their wishes.

The institute said an estimated half a million people died each year in England, with three out of four anticipated by clinicians.

Adults who display symptoms suggesting they may be in the last days of life should be monitored for further changes, said the guidance.

“NICE wants to put the dying person and those important to them at the heart of decisions”

Sam Ahmedzai

This will help to identify if they are nearing death, stabilising or recovering, said NICE, adding that it would allow the person and those close to them to prepare accordingly.

It noted that some people could experience difficulty in swallowing during their final days of life.

NICE said necessary changes to prescribed medicine – for example, providing injections instead of tablets – should be anticipated so that the person is not left without essential medication.

Sam Ahmedzai, emeritus professor of palliative medicine and specialist member of the NICE quality standard committee, said: “Control of pain and other distressing symptoms is very important for dying people, but good end of life care goes far beyond that.

“It includes asking about the dying person’s spiritual, cultural, religious and social preferences,” he said. “Only by attending to these issues and concerns can we deliver truly individualised care for each person and those important to them.”

He added: “NICE wants to put the dying person and those important to them at the heart of decisions. This means asking people what they want and providing what they need, whenever possible.”


Gillian Leng

Professor Gillian Leng, deputy chief executive of NICE, said: “Our guidance will support doctors, nurses and other healthcare professionals so that they can work together to ensure that people die with dignity, whenever possible in the place of their choosing and with their symptoms effectively controlled.”

Claire Henry, chief executive of the National Council for Palliative Care, backed the new standard from NICE.

“We all have a right to good quality end of life care, although not everyone currently receives this,” she said.

“This standard for the care of dying adults will help people nearing death to receive the care they deserve,” she added.

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