Health & care workers urged to do more to ask dying people about spiritual beliefs

Health and care workers looking after dying people in their final days must do more to ask about spiritual beliefs, experts have said.

Spiritual wishes were only documented for one in seven people who died in hospitals in England who were able to communicate in their final days, a 2016 report found.

Now the National Institute for Health and Care Excellence (Nice) has urged health and care workers to do more to ensure they take into account cultural, religious or social preferences of adults in their final days.

A new quality standard from the health watchdog sets out standards of care for those aged 18 or over in their last two to three days of life.

Nice said that of the half a million deaths each year in England, three-quarters of these deaths were anticipated by medical staff.

It has set out a series of measures which should help those in their final days.

People should be given an individualised care plan and dying people, and those important to them, should be given opportunities to discuss the care they want to receive.

This should include asking the person where they want to be cared for and any cultural, religious or social preferences.

It also sets out a series of reviews for health and care professionals, including how they may need to anticipate that a patient will need to switch from an oral medication to an injected one.

Their hydration needs should assessed daily, Nice said.

“Control of pain and other distressing symptoms is very important for dying people, but good end of life care goes far beyond that,” said Sam Ahmedzai, emeritus professor of palliative medicine and specialist member of Nice’s quality standard committee.

“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.

“How we are cared for can make a big difference to our final days, and lives on in the memories of family and friends.

“Nice wants to put the dying person and those important to them at the heart of decisions.

“This means asking people what they want and providing what they need, whenever possible.”

Professor Gillian Leng, deputy chief executive of Nice, added: “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.”

Commenting on the document, Claire Henry, chief executive of the National Council for Palliative Care, said: “We all have a right to good quality end of life care, although not everyone currently receives this.

“This standard for the care of dying adults will help people nearing death to receive the care they deserve.”

The Revd Dr Brendan McCarthy, the Church of England’s national adviser on medical ethics, added: “This guidance builds on Nice’s 2011 recommendations for care at the end of life that highlighted the essential need for spiritual and religious care to be made available to all.

“It is distressing that currently 85% of patients in acute hospitals are not offered this care because their wishes are not sought.

“The new Nice guidelines remind us that we must do better and they underscore the vital role that chaplains play as part of a multi-disciplinary team in delivering holistic care at the end of life.

“It is important that their role is recognised, encouraged and supported in the interests of delivering better patient care.”

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