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Palliative care prognosis conversation call

Friday November 29th, 2013

A ground-breaking study into palliative and end-of-life care has found that failing to discuss prognosis with patients is detrimental to them.

There is also a “significant gap” gap between NHS palliative care policy and current practice, according to the research conducted by the University of Sheffield's School of Nursing & Midwifery.

The study, published in the NIHR Journals Library, found that while many patients and their families wanted to have conversations about the prognosis and care, it is routinely ignored in hospitals.

The report comes as the British NHS seeks alternatives to the Liverpool Care Pathway to provide models of good care for dying patients.

One doctor told researchers: “We never do that – I think for a variety of reasons. It’s not because we don’t want to provide information but quite often breaking bad news to a patient can be pretty difficult and we take a very different approach which may not be right but unless the patient asks for their prognosis, we don’t tell them the prognosis.”

However, the son of a patient with palliative care needs said being open was important. He described how his father told his doctor: “Look I don’t want no shilly-shallying; if there’s anything wrong I want to know. Just tell me straight.”

The study involved more than 500 patients and 50 medical staff. Health care professionals admitted it was difficult to recognise that a patient had entered the last 12 months of life, adding that prognosis was not routinely discussed with hospital inpatients.

This represents a barrier to a structured transition to palliative care being initiated, despite improving provision of palliative and end of life care being a priority for the NHS, say the researchers.

Principal investigator, Professor Christine Ingleton, professor of palliative care nursing at the School of Nursing and Midwifery, said: “The number of people requiring palliative care is increasing rapidly in the UK because of our ageing population. Most people want to make choices about the care and treatment they receive at the end of life.

“However, our research shows that a failure on the part of health professionals to discuss prognosis and goals of care means that many are not given this opportunity. Only a small minority of patients will receive care from specialist palliative care clinicians; most will be cared for by non-specialists.”

An urgent need to build capacity in palliative care management among clinicians working in the acute hospital setting was also identified. Medical staff need support to help them discuss prognosis, and care and treatment options at the end of life, with their patients, concluded the report.

Tags: NHS | Nursing & Midwifery | Pain Relief | UK News

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