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Table 1 Pertinent examples of ongoing documents and initiatives relating to care of the dying

From: Clinical decision making in the recognition of dying: a qualitative interview study

Document/initiative Brief description Reference to recognising dying
NHS End of Life Care Strategy [33] National framework and vision for end of life care in the NHS; remains a foundation document in context of changing landscape. Identifying people approaching the end of life is highlighted as one of seven key areas relevant to commissioning and delivering care.
The Liverpool Care Pathway version 12 [8] (now withdrawn). Previous national guidance on end of life care. Now withdrawn. Recommended a multi-disciplinary approach with regular reviews of decisions and patient condition.
The route to success – transforming end of life care in acute hospitals [38]. Original document supporting NHS managers and clinicians responsible for delivering end of life care. Latest version in progress. “How to” guide below. Reinforces points made in the End of Life Care strategy, above; “Early recognition that a patient is dying is a key element in quality end of life care.”
Transforming end of life care in acute hospitals – The route to success “how to” guide [39] Latest advice on implementing “The route to success” document, above. Draws multiple resources together to produce a coherent guide. Repeated references as cited in other resources.
More Care, Less Pathway [10]. The independent review into the LCP. Highlighted that failure to recognise dying accurately was a key weakness of implementing the LCP
One Chance to Get it Right, Five priorities for end of life care [5]. Document summarising recommendations from the Leadership Alliance for the Care of Dying People (LACDP). Summarised in Five Priorities for end of life care. First of five priorities cited is to “recognise and communicate that a person is dying”. Complexities and challenges recorded as part of discussions.
National Institute for Health and Care Excellence (NICE) Guidance: Care of dying adults in the last days of life [6]. National guidelines on end of life care. First section is advice on recognising dying, with discussion of challenges and complexity of decisions.
First research recommendation relates to recognising dying.
Ambitions for palliative and end of life care: A national framework for local action: 2015–2020 [40]. Document produced by a partnership of organisations, outlining ideals and targets for improving palliative and end of life care in England. Acknowledges the difficulty and uncertainty in recognising dying, and the importance of honest discussions as part of individualised care (Ambition 1)
National Care of the Dying Audit for Hospitals, England: National Report May 2014 [1]. Document summarising audit of end of life care in England in 2014. Made key recommendations, based on audit findings and results of Neuberger review. Recommends that recognition of dying is undertaken by the multidisciplinary team and communicated to patients/families.
Actions for end of life care: 2014–2016 [41]. Intended as a document revisiting and refreshing the end of life care strategy (above). Includes a commitment to work with organisations to improve ability of professionals to recognise dying. (Section 5.2, commitment 10).
AMBER care bundle [42]. (AMBER is an acronym: Assessment, Management, Best Practice, Engagement, Recovery Uncertain) A decision-making tool supporting advance care planning and setting ceilings of care in unwell patients. Recommended as part of Ambitions for palliative and end of life care (above) Part of the role of the tool is to explore appropriate actions in event of deterioration, to guide end of life vs acute care; recognition of dying is therefore implied.