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What are the core components of 'best care for the dying'? Progress on the 10/40 Model Delphi Study

Ensuring that dying patients receive high quality and equitable care, no matter their diagnosis or location of care, is a core part of the vision that has shaped the work of the International Collaborative for Best Care for the Dying Person.

Caring for people in the last days of life can present a wealth of ethical and moral challenges, and a pervasive view exists that good end-of-life care outside of the hospice environment is hard to get right. For example, end-of-life care in the acute and primary healthcare setting is challenged by insufficient mechanisms to identify patients who are nearing the end-of-life and poor communication between care teams, as well as a lack of guidance with which to inform care delivery at this time.


The 10/40 Model for Best Care for the Dying Person is a model of care which aims to ensure that dying people can be provided with safe, high quality care by appropriately-educated staff working within a supportive organisational governance structure, wherever they happen to die. The Model was developed by the International Collaborative following a review of the best available evidence in end-of-life care, and was underpinned by the publication in 2013 by Ellershaw and Lakhani, ‘Best care for the dying patient: Why do so many people die badly when we know how to care for them well?’


To ensure that the 10/40 Model reflects up to date best available evidence and expert opinion, the International Collaborative has undertaken an international Delphi study to assess the importance of the model's core elements to re-establish an international consensus on what constitutes ‘best care for the dying’.

The Delphi study involves two rounds of a Delphi Questionnaire, followed by a consensus meeting to agree the content of the 10/40 Model going forward. This study is a collaboration between Professor John Ellershaw, Professor Carl Johan Fürst, Professor Lia van Zuylen and their respective research teams in the UK, Sweden and the Netherlands.


Round 1 of the Delphi questionnaire was completed in February 2021, with 166 participants from across 20 countries. The Round 1 questionnaire asked participants to rate their level of agreement against each of the 10 Key Principles and 40 Core Outcomes. Free text comments against each item were also sought.

Results from Round 1 were used to inform the design of the Round 2 questionnaire, which was completed in April 2021 with 75% of participants from Round 1.


A final consensus meeting will now be held, with participants from Round 2 invited to attend.

We hope that the resulting international consensus on what constitutes 'best care' for the dying person will provide a robust contribution to the evidence base and support clinicians in overcoming the inherent challenges of providing optimal care for patients at the end of their lives. We look forward to sharing the results in due course.

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