End of Life Care education programme

The AHSN End of Life Care (EOLC) project aims to improve the care that patients and those important to them experience in the last weeks and days of life.

In response to their mandate to prioritise education and training on care of the dying, Health Education England (HEE) in north central and east London has funded UCLPartners to develop and deliver innovative educational material to train generic clinical and non-clinical staff in the delivery of high quality end of life care (EOLC). The material content incorporates the five priorities of care set out in the Leadership Alliance report One chance to get it right alongside the document Ambitions for Palliative and End of Life.

One of the emphases of the project is to improve communication between professionals and patients, including discussions related to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR).

The strategic objectives of the programme are to:

  • Produce a suite of educational material appropriately targeted to clinical and non-clinical staff in both hospital and community settings. The material should be designed to be used flexibly and modified in line with local need. It should also cover the required approach to:
    – Care in the last weeks and days of life, in light of the One chance to get it right report and the Ambitions for Palliative and End of Life Care document
    – Make and communicate DNACPR decisions, in light of the Tracey vs Cambridge judgement
  • Ensure sustainability of the project by disseminating to local trainers through train-the-trainer sessions; providing bespoke support for individual acute trusts; establishing a Community of Practice (CoP) for acute trusts; and providing a follow up workshop for community trainers
  • Develop tools to enable evaluation of the training material in all settings. The evaluation will also include in-depth evaluation in a few sites.

In line with the aim to produce a suite of educational materials, two products have been developed. Each of which comprise the following:

  • A 17 minute film, that can be shown in its entirety or in smaller sections
  • Structured education material  for trainers including slides, facilitator notes, case examples, and handouts
  • A resource list that provides links to relevant websites and references for further training material
  • Tools to evaluate the efficacy of the training: pre and post training confidence questionnaires, and questionnaires to assess the perception of care in the learner’s environment
  • Material to provide data on use of the material for reporting purposes.

Acute Hospitals Educational material: Milestones – Care in the last days of life in hospital

Milestones is a film which focuses on care in the last days of life in acute hospitals. The film portrays an elderly man’s last days of life, and his care by medical and nursing staff in a hospital setting. The narrative follows the man’s deterioration from lung cancer, and tracks how this is recognised by staff and communicated to the patient and his family. It demonstrates both good and poor communication, and reveals the thinking and communication between the patient and his daughter, as well as the provision of support to each of them.

The educational material can be used to teach the following aspects of end of life care:

  • Recognition of deterioration
  • Effective communication, including DNACPR decision-making and discussion
  • Making an individualised plan of care
  • Physical care at the end of life

The aim is to produce, implement, embed and evaluate the training programme into acute hospitals across London. This includes creation of the educational material, hosting train-the-trainer sessions, providing bespoke support to individual trusts, and establishing a community of practice for those trusts involved.

To date, the project has progressed well with:

  • The Milestones film produced by UCLPartners
  • The Milestones educational material written and packs printed: 45 packs distributed throughout London to date
  • Train-the-Trainer sessions facilitated: 57 clinicians completing from across 27 acute trusts (feedback has been overwhelmingly positive)
  • Evaluation tools to enable data collection created and disseminated
  • Champion trainers commenced teaching ground staff January 2016, with over 1000 trainees completing by September 2016
  • Data collected from trainees shows an increase in overall confidence levels of 20 percent, when dealing with patients, and those important to them at end of life.
  • Community of Practice (CoP) established following an online survey to gather baseline information. The delegates meet every six weeks, alternating between lunchtime webinars and face to face meetings. The agreed aim of the CoP is:

The EOLC CoP will work together and within their trusts on agreed aims to make excellent EOLC
everyone’s business. This will be done by:
a) Equipping generic staff to deliver better care
b) Having a demonstrable positive impact on patient care
c) Increasing strategic engagement

Further areas under each theme were agreed and prioritised. Since the first meeting on 12 November 2015 we have had 50 clinicians engaged from across 40 trusts.

Community Educational Material: You Matter – End of Life Care in the community

You Matter is a film focused on care in the last weeks of life in the community. The film conveys the last weeks of life of a man with heart failure who is married and estranged from his daughter. The film shows care delivered by a Palliative Care Clinical Nurse Specialist and District Nursing staff. As with the Milestones film, both good and poor communication are demonstrated.

The educational material can be used to teach the following aspects of care in the last weeks of life:

  • Preparing for a death in the community; including recognition of deterioration, prognostication, bereavement, cultural and spiritual issues
  • Effective communication
  • Making a plan of care for the last days of life
  • Physical care in the last days of life
  • Advanced Care Planning: discussions and decisions.

The aim of this part of the project is to produce, implement, embed and evaluate the training programme into community organisations across London. The film used in this project has been produced and provided with permission from East London Foundation Trust (ELFT). The UCLPartners team aims to create the corresponding educational material, host train-the-trainer sessions, and provide networking and support for champion trainers.

To date, the project has progressed well with:

  • The You Matter film sourced and agreement in place with ELFT to utilise in UCLPartners educational pack in 2015.
  • The You Matter educational material written and packs printed, dissemination commencing at the Primary Care Educators Conference on 26 January 2016: 66 packs distributed throughout London to date
  • Train-the-trainer sessions facilitated: 102 clinicians completing from across 37 organisations.
  • Feedback again has been very positive
  • Evaluation tools to enable data collection created and disseminated
  • Champion trainers are due to start teaching staff
  • Afternoon workshop for support and networking to be organised soon

Leadership and contacts

Dr Caroline Stirling, End of Life Care Lead
Michelle Mooney, End of Life Care Project Manager