Management of common symptoms for people approaching the end of their life can be challenging.

What are we doing to support professionals?

In order to ensure that they have the right guidance to support their patients a Palliative Care Clinical Practice Summary has been developed covering the main problems that people might encounter. This supports decision-making in symptom management and care coordination for people in the last weeks of their life. If there is any doubt regarding clinical decisions for individuals, help should be sought from local Specialist Palliative Care services.

The North West Coast Clinical Practice Summary has been reviewed and updated in 2025. The 2025 updated guidance is based on previous editions developed in 2012 and reviewed in 2014, 2017 and 2021 separately in LSC and C&M and latterly across the North West Coast.

We have worked hard to try and achieve consensus and base the practice summaries on the best available evidence. We hope that in doing this we can help to ensure a consistency of approach to managing common symptoms, particularly for those individuals who receive care in a number of different locations.

Whilst every care has been taken to ensure accuracy and clarity, prescribers and clinicians must make all their decisions based on a full clinical assessment and their assessment of the risks and benefits of any intervention.  They must also take into account any local guidance where it exists. Contact your local Specialist Palliative Care team if advice required.

The evidence-base for prescribing in palliative care is not extensive or robust, which means that some guidance is based on a consensus of expert opinion.  Many medications are used beyond licence and at doses that differ from other areas of clinical practice. This makes it impossible to produce guidance that contains definitive statements about what to prescribe and when.

The summary includes guidance on managing symptoms in bowel obstruction, breathlessness, constipation, nausea & vomiting, pain, palliative care emergencies, respiratory tract secretions, agitation, continuous subcutaneous infusions and renal failure.

North West Coast Palliative Care Clinical Practice Summary 3rd Edition 2025

This is not mandated guidance and there is no expectation that localities should adopt it if they have local guidance that works for them.