Nurses have a 'duty' to talk to patients about death

First audit of end of life care since withdrawal of Liverpool Care Pathway publishes its findings

Improvements have been made to end of life care provided by hospitals, but access to care and variation in quality remains a concern.

The conclusion comes from an audit of palliative care carried out by the Royal College of Physicians (RCP), which examined the cases of 9,302 patients at 142 NHS organisations in England.

It was the first such investigation since the withdrawal of the controversial Liverpool Care Pathway (LCP) in 2014.

At a launch event yesterday (March 30), RCN professional lead for long-term conditions and end of life care Amanda Cheesley admitted that her fellow nurses had expressed concerns following the withdrawal.

However, she hailed the audit as proof that ‘people are committed to making things better’ and said it 'went a long way to addressing those concerns’.

Ms Cheesley highlighted the fact that 93% of the trusts in the audit had demonstrated clear training in end of life care was in place for all nurses.

Yet she also expressed anxiety at the (unrevealed) number of nurses who could not access such training due to ‘lack of back fill on wards’.

Positive findings outlined in the audit included:

  • 25% of people recognised as ‘likely to die’ had documented evidence of having a discussion about their death with a health professional.
  • For the main symptoms present around the time of death, there was evidence of controls delivered for: pain in 79% of cases; agitation in 72%; breathing difficulties in 68%; and nausea/vomiting in 55%.
  • 67% of cases had evidence of a patient’s ability to drink in their final 24 hours of life, while clinically assisted hydration was in place for 43% of patients during the same time period.

Negative findings included:

  • Only 13% of trusts (18/142) had specialist palliative care beds.
  • Only 11% (16/142) offered a face-to-face palliative care service around the clock.
  • Recordings showed that only 32% of patients had opportunities to have their concerns listened to.

Ms Cheesley added: ‘All nurses need to be able to identify when things go wrong and feel confident enough to do something about it.

‘Communication is absolutely vital. Nurses have a duty to have the conversation about death with patients and to be kind and caring, because it is not only a professional duty but a human one.’

LCP was widely criticised in the media as nothing more than a ‘tick-box’ exercise leading to ‘self-fulfilling’ diagnosis, and the Department of Health eventually agreed it should be scrapped.

RCP Clinical Effectiveness and Evaluation Unit medical director Kevin Stewart, who led the audit, acknowledged that the funding provided by the Healthcare Quality Improvement Partnership meant it could only take place in England.

He expressed a wish to conduct a similar review in the rest of the UK and beyond only hospital care in the future.


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