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The Liverpool Care Pathway version 12 [8] (now withdrawn).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 Now withdrawn.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. |