BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4792 (Published 07 September 2015)
The recent draft guideline from the National Institute for Health and Care Excellence on care of the dying is a good summary of evidence but not much help at the bedside, two experts on palliative care have said.
Since the demise of the Liverpool care pathway, acute trusts have been left to their own devices over adult palliative care, Jonathan Koffman and Katherine Sleeman, from the Cicely Saunders Institute in London, told journalists at the Science Media Centre, London, on 3 September. They said that NICE’s 266 page guideline,1 which is out for public consultation until 9 September, provided no substitute for the Liverpool care pathway, which was abandoned after a review by Julia Neuberger in 2013 found a lack of strong evidence for either its benefits or its harms.2
The Liverpool care pathway had the virtue of brevity but had tended to become little more than a “tick box” that was inconsistently interpreted, Sleeman said. “Caring was often wholly absent” in the care of the dying, she said. The pathway was blamed in the media for egregious examples of poor care, and Neuberger’s review applied the final blow.
But what is left is far from ideal. Half of all deaths occur in hospital, but little training is given to either doctors or nurses about how to handle them. Dying patients are not a vocal constituency, said Koffman, and their family members do not often wish to dwell on their loved ones’ last days. But he cited the words of Cicely Saunders: “How people die remains in the memory of those left behind.”