Old person hospital admissionCultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in seven people who were able to communicate their desires.

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. Only by attending to these issues and concerns can we deliver truly individualised care for each person and those important to them.”

It’s estimated that about half a million people die each year in England and three out of four of these deaths are anticipated by medical staff. Adults who display symptoms suggesting they may be in the last days of life should be monitored for further changes, the guidance says. This will help to identify if they are nearing death, stabilising or recovering, which will allow the person and those close to them to prepare accordingly.

Some people can experience difficulty in swallowing during their final days of life. NICE says 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.

Professor Gillian Leng, deputy chief executive of NICE, said: “We know the vast majority of people in this country receive very good care at the end of life, but this isn’t always the case. “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.”

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