Improving quality in hospital end-of-life care: honest communication, compassion and empathy

Abstract

BackgroundWith over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: ‘Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…’MethodsThe modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated.FindingsFive themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice.ConclusionLearners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention—behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.

Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

“…Effective communication requires open and honest conversations that contribute to respectful and compassionate care and has been described as important from the patients' perspective [33,34]. The concept of honesty [24] was reported by learners in the current study as important, as was empathy [35], listening [12], support, reassurance, and kindness, with such caring behaviour a vehicle to instil hope [36]. Hope has been described as a "powerful and vital coping mechanism for a person who is nearing the end of their life" [37] (pp.…”

“…Many expected patient deaths take place in hospital, with the overall quality of end-of-life care in these settings requiring substantial improvement [19]. In order to improve end-of-life care, HCP require upskilling in both knowledge and abilities [12]. Completion of the chronic complex illness module led to a self-reported significant, positive influence on the knowledge, skill, attitude, and confidence of learners in provision of end-of-life care to patients living with chronic complex illness.…”

“…Module development was informed by an educational framework addressing quality matters, and in consultation with an Advisory Group, industry partners, and peer reviewed by Australian clinicians for currency and relevance [12]. Modules are based on the ACQSHC National Consensus Statement: essential elements for safe and high-quality end-of-life care [8].…”

“…It is possible that responses by non-responders to the evaluation component of the modules would show different perspectives to those who have participated in the evaluation and provide alternate viewpoints. There is also a limitation in responding to a single question without any further critical insight into what practice change would look like [12].…”

“…HCP report that it is often easier to continue treatments than to talk and plan care with patients and families about the End-of Life [11]. Fear, denial, and unrealistic expectations by HCP can lead to a cascade of invasive treatments or referrals that result in poor end-of-life care [12]. This not only influences HCP clinical practice, but also health resource utilisation [13].…”