Clinical Practice Guidelines for the Last Days of Life: A Systematic Review

Area of Science:

• Palliative Care
• Clinical Practice Guidelines
• Systematic Review

Background:

• Contemporary clinical practice guidelines (CPGs) for end-of-life care (LDS) are crucial for patients, families, and caregivers.
• Evaluating existing CPGs is essential to ensure high-quality care during the final days of life.

Purpose of the Study:

• To systematically identify and evaluate current clinical practice guidelines for adult patients in their last days of life.
• To assess the methodological quality and categorize recommendations of selected CPGs.

Main Methods:

• Systematic review adhering to PRISMA guidelines, searching multiple databases (PubMed, TRIP, Cochrane, etc.) for CPGs published 2016-2025.
• AGREE II instrument used by four evaluators to assess the methodological quality of 16 CPGs, with eight ultimately included.
• Recommendations were categorized into 12 decision areas, and a narrative synthesis was performed due to heterogeneity.

Main Results:

• Eight CPGs from five countries (UK, Spain, USA, Canada, Europe), published 2018-2021, were included. Overall AGREE II scores ranged from 71% to 100%, with low scores in Applicability.
• Strong recommendations were found for recognizing the dying phase (LDS), communication, and interdisciplinary coordination.
• Symptom management recommendations were mixed, and gaps were noted in social, cultural, and spiritual dimensions of care.

Conclusions:

• Findings can guide healthcare professionals and managers in selecting key recommendations for end-of-life care.
• Future guideline development should address identified gaps in social, cultural, and spiritual care dimensions.
• Limitations include heterogeneity in guideline methodologies and a restriction to English and Spanish publications.