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

Background/Objectives: To identify and evaluate contemporary clinical practice guidelines for the care of adult patients in their last days of life, their families and caregivers. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement (PROSPERO: CRD42021258311). PubMed, TRIP Database, Cochrane Library, ProQuest, and CINAHL were searched for CPGs published between January 2016 and December 2025 in English or Spanish, supplemented by searches of seven palliative care organisation websites. Two independent reviewers screened records; the AGREE II instrument was applied by four evaluators to assess methodological quality. Recommendations from included guidelines were categorised into 12 inductively derived decision areas encompassing recognition of the dying phase, communication and decision-making, multidisciplinary care, symptom management, and grief and bereavement. A narrative synthesis was adopted due to heterogeneity in guideline structure and recommendation grading systems. Results: Of 1118 records identified, 20 were retrieved for full-text assessment. Sixteen met CPG criteria and were appraised with AGREE II, of which eight were finally included. Included guidelines originated from five countries (UK, Spain, USA, Canada, and Europe) and were published between 2018 and 2021. Overall AGREE II scores ranged from 71% to 100%, with the lowest domain scores consistently found in Applicability. Strong recommendations were identified across most guidelines for recognition of the LDS, communication, and interdisciplinary coordination; recommendations on symptom management were mixed. Conclusions: Findings may inform professionals and health system managers in identifying key LDS care recommendations. Gaps in social, cultural, and spiritual dimensions should guide future guideline development. Key limitations include heterogeneity in guideline methods and restriction to English and Spanish publications. No external funding was received.