End of life care for adults: service delivery

Context

End of life care is defined by NHS England as care that is provided in the 'last year of life'; although for some conditions, end of life care may be provided for months or years. After the Liverpool Care Pathway was withdrawn in 2014, a number of national reports, guidelines and policy documents began to describe the changes needed for a new approach to end of life care services. They identified that high-quality, timely, compassionate personalised care and support planning, including advance care planning, should be accessible to all those who need it. To progress this intention, the models of care and the service delivery arrangements that need to be put in place for people as they approach the end of their life need to be defined.

End of life care may be delivered by disease-specific specialists and their associated teams; by generalists such as primary care teams or hospital-based generalists (for example, elderly care); or by palliative care specialists in hospices, hospitals and community settings. Giving this type of care can ensure that people live well until they die. Care that is given alongside, and to enhance, disease-modifying and potentially life-prolonging therapies, often for years, can be called 'supportive care'. Care that is primarily conservative and aimed at giving comfort and maintaining quality of life in the last months of life is commonly referred to as palliative care. Palliative care particularly aims to provide relief from pain and other distressing symptoms, integrate the psychological, social and spiritual aspects of the person's care, and continue to offer a support system to help people to live as actively as possible until their death. In this guideline, end of life care includes both supportive and palliative care. However, the terms used for this can vary, for example, end of life care is referred to as 'conservative care' in the NICE guideline on renal replacement therapy and conservative management.

This guideline describes the provision of end of life care services for adults approaching the end of their life with any conditions and diseases. The guideline advises on service models for care in acute settings by disease-specific specialists and their supportive services, and in community settings by primary care or specialists in palliative care (for example, in hospices). It is intended to be used alongside the NICE guideline on care of dying adults in the last days of life, which covers care planning and clinical interventions for people who are considered to be in the last days of life.