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Case study 3: The Conversation Project

End-of-life care has a profound impact on patients and their loved ones. But patients do not always have the opportunity to share with staff what they would like this care to look like. For their PFCC project, the Royal United Hospital Bath chose to focus on this aspect of care as they knew it was important to patients and it was a high priority for the board too.

‘As clinicians, we often don’t recognise when people are dying, so we don’t have good conversations at the end of their life and act more appropriately in their care as a result of that,’ Robin Fackrell, Consultant of Care in the Elderly, explained. ‘If we are too interventional, we can do unnecessary things that can detract from comfort and dignity.’

The clinicians who made up the project steering group shared a clear idea of what they wanted to achieve. They felt that once staff knew patients were dying, they were clear about how to offer the best care. The team decided to focus on the stage before, when there was a lack of certainty about whether the patient should be receiving end-of-life care or not.

The working group was made up of staff on one ward, who met for half an hour fortnightly and ran an action plan approach. Interventions were tested on that ward and improved. The key intervention involved the end-of-life care lead nurse and the end-of-life care facilitator attending multidisciplinary whiteboard meetings, when staff would stand at a whiteboard and discuss patients one by one. The two co-ordinators would encourage conversations about patients who might benefit from end-of-life care planning and ran ad hoc teaching sessions for the nursing staff. Staff were also encouraged to share their experiences of holding end-of-life discussions with patients and loved ones, and to learn from one another.

The team tested the changes on just one ward, before rolling them out to another five. But there are plans to spread the approach further still. ‘It is a journey,’ Chief Operating Officer Francesca Thompson said. ‘We want it to continue and spread across the whole hospital and extend into the community so it becomes more of a whole-system approach.’

The project has identified that not every member of staff feels comfortable talking about this sensitive subject with patients and families. However, through the regular meetings, these staff can now highlight these patients to their colleagues so the team can identify the right person to have this conversation.

The project resulted in a range of benefits – not least, raising awareness about end-of-life care and the importance of communication at that time. ‘We’re changing the culture of the way in which we approach patients,’ Robin Fackrell said. ‘Engaging with patients and carers earlier and involving them very much in planning for their future is something that the medical profession has been relatively poor in doing in the past because we think we know best. We need to refer to the people we’re trying to influence: the patients. Often they have the answers – we just have to engage them in the conversation to find out what they are.’

This video tells you more about The Conversation Project: