The materials aim to increase staff confidence across areas including recognition, communication and physical care, for those in their last weeks and days of life. Each set of materials include a short film, teaching slides and activities. The first film, Milestones, depicts a patient’s experience in an acute hospital, and the other, You Matter, shows the experience of a man dying in his own home. The materials centre on the films and utilise a reflective session to engage staff in discussion about what is important for people at the end of their life.
The materials have been highly rated by trainers, and learners have reported an increase in confidence as well as a positive impact on their practice. The ultimate aim is to improve conversations between staff and patients and those important to them – in turn enabling patients’ wishes and preferences to be met, a decrease in avoidable hospital admissions, and an increase in those who die in their preferred place. The challenge End of Life Care (EOLC) is one of the core eight services inspected by the Care Quality Commission, and now a priority for the NHS.
- By 2035 the total number of deaths in the UK per year will increase from 480,000 to 550,000, of which approximately three quarters are expected rather than sudden
- Most people would choose to die at home, yet large numbers die in hospitals
- Quality of EOLC has been highlighted by the Parliamentary and Health Service Ombudsman
- Health Education England has prioritised education and training on care of the dying in its 2014-15 to 2017-18 mandates and draft health and care workforce strategy for England to 2027
- The Leadership Alliance for the Care of Dying People report ‘One Chance to Get It Right’ outlined five priorities for the care of patients and those important to them: Recognise, Communicate, Involve, Support, Plan and Do
The UCLPartners End of Life Care Education project aimed to embed excellent care, outlined by the five priorities of care, into routine practice for staff caring for patients and those important to them during the last days of life.
What we did
Funded by Health Education England North Central and East London, and led by Dr Caroline Stirling, Consultant in Palliative Medicine and Director for End of Life Care NHS England (London region) UCLPartners AHSN identified the need for an innovative educational resource. UCLPartners set about creating a suite of materials that could be used by facilitators to teach staff of all grades and disciplines, across all settings. The community materials were made in partnership with East London NHS Foundation Trust, who produced the You Matter film.
The materials were disseminated through a train the trainer approach. UCLPartners also established a quarterly Community of Practice for acute hospital EOLC Leads across London and the South East, to support the improvement of EOLC including workforce development, shared documentation and metrics, and other improvement initiatives.
Through the Community of Practice, UCLPartners have developed a Bereaved Carers Survey template and data collection tool in partnership with the Cicely Saunders Institute at King’s College London. The template supports service improvement and benchmarking, and is currently in use in at least 7 Acute Trusts across London.
Between January 2016 and March 2018:
- The materials have been utilised at least 386 times by 34 organisations across London, Essex, Hertfordshire and other areas
- 2,937 staff in acute hospitals and the community have been trained using the materials
- Data analysis of pre and post training confidence surveys has shown an overall increase in confidence of ~20%
- An in-depth evaluation of 54 learners (across acute hospitals and the community) 3-8 months post-training found this increase in confidence was sustained
- Evaluation of data for the acute hospital staff was analysed and it was found the sustained confidence levels were statistically significant
- 83% of staff reported the training had a positive impact on how they deliver care
Potential patient impacts:
- Early recognition of those that are at end of life – resulting in increase in DNACPR (do not attempt CPR) discussions and decisions, Advance Care Planning, Treatment Escalation Planning
- Increase in sensitive communication, person-centred care, and patient and family involvement
- Improved end of life experience for patients and those important to them
Potential financial impacts:
- Reduction in avoidable hospital admittance
- More efficient discharge where the place of care/death identified
- Reduction in unnecessary treatments
- Clinical time saved
- 34 organisations actively engaged across London, Hertfordshire, Bedfordshire and Essex
- Funding secured to develop specific care home educational resource
- Oral presentation at European Association of Palliative Care, 2017
- Hong Kong Palliative Care Conference – Holistic Journey, 2017
- Both Milestones and You Matter material have been included in University College London Medical School ‘Legal & Ethical decision making’ Undergraduate Year 5 module
- “(I’m) more confident to discuss patient end of life wishes and offer care planning – via GP.” – You Matter learner
- “Helped me to be aware of the importance of communication and seeing each patient as an individual.” – You Matter learner
- “The training helped me to identify that my patient was dying and explain my thoughts to the doctors looking after her.” – Milestones learner, North Middlesex University Hospital
- “The Milestones EOLC Package has proven to be a fantastic educational resource for us here at Barts Health. The materials, including the powerful short film, session plans, slides, and teaching notes provide everything needed to run an effective and engaging session with a wide range of staff.” – Graeme Hendry, EOLC Education Programme Manager at Barts Health NHS Trust
Plans for the future
UCLPartners have been commissioned by Health Education England to develop and pilot educational materials to give care home staff the knowledge and skills needed to deliver excellent care for patients at the end of life.
We have created What’s Best For Lily?, an 11-minute educational film showing the last months, days, and weeks of a patient’s life through the eyes of a care home resident with dementia, her son, and a carer. Accompanying resources support facilitators to deliver teaching sessions and activities on topics including recognising gradual and sudden deterioration; asking about a resident’s wishes and making a plan of care; prompts to review before calling 999; supporting loved ones and involving them with care; and dealing with the death of a resident.
A small-scale implementation pilot of the educational materials is being conducted in care homes in Camden and Enfield.
Data collection and dissemination of Milestones and You Matter is ongoing.