The Royal College of Physicians and NHS National End of Life Care Programme surveyed nearly 2,000 hospital registrars (who were newly qualified), hospital consultants and specialists. Focus groups were also conducted. Overall, more training in end-of-life issues and was identified as being crucial to the delivery of care.
Key findings indicate that tools for coordinating end-of-life care pathways are working, but that training in their use should be encouraged so they don’t become tick-box exercises. Training in long-term conditions should have equal priority as for cancer care. One example of where this can improve the quality of care is the use of clinical champions for Motor Neurone Disease who work alongside healthcare professionals, training them in awareness of the condition and end-of-life issues etc.
Physicians reported high levels of confidence in the provision of end-of-life care (although the report suggests that this is sometimes misplaced), but that the earlier identification of patients entering their last phase of life and planning with them for their preferences for care is an area that they lack confidence in. Findings from the focus group indicated that initiating difficult conversations was difficult, but that there has been a cultural shift and that end-of-life care shouldn’t be seen as ‘giving up’, but rather about ‘giving alternatives’.
The second report is from the NHS National End of Life Care Programme which examined complaints relating to end-of-life care in four hospital trusts in England. In 2007 the Healthcare Commission found that 50% of unresolved complaints in acute trusts were related to care at the end of life. However, findings from this NHS report put this figure at 4% over a period of four months. Complaints and critical incidents in the Royal College of Physicians report were also relatively low.
What the NHS report revealed was that most of the complaints related to communication issues, which is usually true of most complaints regardless of the area of care. The authors concluded that more robust research is needed to examine this.
So the jury is still out on end-of-life care complaints and more training is needed in longer-term conditions, having difficult conversations and advance care planning for physicians. But to end on a more positive note there appears to have been a cultural shift amongst physicians around end-of-life care.