With thanks to the members of the West Midlands Palliative Medicine Physicians Society who contributed content to this updated version, led by by Dr Nial McCarron with special thanks to Dr Debbie Talbot, Dr Fran Hakkak, Sonia Chand, Dr Maddy Turley & Dr Sophie Rayner.

Online editing by Dr Anna Lock with support from a team of WMPCPS proof readers.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.