A new report from the Royal College of Physicians (RCP) recommends that all hospital doctors, not just palliative care doctors and geriatricians, must be supported to improve the care they give to patients at the end of their lives.
Improving end-of-life care: professional development for physicians, published by the RCP, provides practical toolkits for physicians and recommendations for trusts to improve end of life care. The report recommends that all physicians promptly discuss options for end of life care, which gives patients and their carers time to make choices. Decisions are then more likely to be shared with health professionals.
Timely, open discussions with patients and carers about the aims and limitations of treatment can enable people to consider their priorities for care. When this is done, more patients would choose care at home and more would achieve their wish to die in their usual place of residence.
Research conducted for this report found that physicians are least confident when dealing with advance care planning for people with dementia. Physicians should be supported to develop their skills in this area of care, via continued professional development programmes for example.
However, the survey of almost 2000 found only a third of respondents had attended any learning event on end of life care in the last 5 years. This is disappointing given the recent focus on end of life care, the development of tools for managing the last days of life in acute trusts, advance care planning,[i] and with new guidance from the GMC published in 2010.[ii]
There is demand from doctors for continued professional development in end of life care. However, doctors reported a lack of support by their trusts to provide this type of training for them and other healthcare staff. Trusts need to embed end of life care into routine practice for all staff.
The report recommends that trust boards make the delivery of high-quality care at the end of life a priority for their organisations. Developing end-of-life care metrics based on the End of Life Care Strategy[iii] quality markers for acute hospitals is key to prioritising end of life care. This should be included in management dashboards and risk registers.
Professional development for end of life care is needed to strengthen multi-professional teams and promote collaboration between team members support the development of effective communication skills.
Dr Fiona Hicks, consultant in palliative medicine and chair of the RCP’s working party on improving end of life care said:
While doctors always aim to do their best for their patients, for a variety of reasons, some physicians are not delivering the best care in the last phase of life. A quarter of a million people die in hospitals in England every year. All physicians must be supported to improve their skills in caring for patients facing the end of life.
Dr Linda Patterson, clinical vice president of the Royal College of Physicians said:
Patients are often at their most vulnerable when facing the end of their lives. At this time, patients need care and compassion. Physicians must be able to facilitate shared decisions with patients when possible, and wherever possible ensure that patient’s preferences are met. This report provides excellent tools for physicians to help them improve the care they give patients at the end of their lives and I urge trusts to embed high quality end of life care into the culture of all hospitals.
Claire Henry, director of the National End of Life Care Programme, said:
This working party report has excellent useful tools for physicians and managers to use. It complements our extensive transforming end of life care in acute hospitals initiative and corresponding ‘how to’ guide which was published in February. Combined these provide a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life. I urge all physicians that care for people who are dying, not just palliative care doctors, to use these tools in their everyday work.
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[i]Royal College of Physicians (2009). Concise guidance to good practice – advance care planning. http://old.rcplondon.ac.uk/clinical-standards/organisation/Guidelines/concise-guidelines/Pages/Advanced-Care-Planning.aspx
[ii]General Medical Council (2010). Treatment and care towards the end of life: good practice in decision-making. http://www.gmc-uk.org/guidance/ethical_guidance/6858.asp
[iii]Department of Health (2008). End of Life Care Strategy: Promoting high quality care for all adults at the end of life. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance
- In developing this report, the working party conducted an online survey of nearly 2000 physicians which was followed by focus groups and telephone interviews.
- The RCP’s working party was chaired by Dr Fiona Hicks Consultant in Palliative Medicine, Leeds Teaching Hospitals Trust; Senior clinical lead for end-of-life care, Yorkshire and the Humber SHA.
- Summary leaflets and the full report are now available.
- Transforming End of Life Care in Acute Hospitals: the route to success ‘how to’ guide, was published by the End of Life Care Programme on 6 March 2012.
Royal College of Physicians
The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. It provides physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 26,000 fellows and members worldwide, it advises and works with government, the public, patients and other professions to improve health and healthcare.