Palliative and End-of-life Care

Key Message

Palliative and End-of-life Care Adopting a palliative and end of life care approach is an integral aspect of the care for those living with and dying from any advanced, progressive or incurable condition.

Palliative and end of life care focuses on the person, not the disease and applies a holistic approach to care. It is designed to meet the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness, death and bereavement. It advocates an approach which recognises the diversity of life circumstances of people who will need palliative and end of life care and which is responsive to these circumstances, whether they relate to age, disability, gender, race, religion/belief or sexual orientation.

Most practitioners will care for patients who require palliative and end of life care. People often associate this with care for people with cancer. However, patients with other advanced, progressive and life limiting conditions such as Dementia, COPD and Multiple Sclerosis also require palliative and end of life care. Palliative care is not just about care delivered in the last months, days and hours of a person's life but is supporting a quality of life for both patients and those close to them at every stage of the disease process.

What does this mean for the Effective Practitioner?

Effective practitioners support individuals, their family and carers along the entire palliative and end of life journey. Assessment and review of palliative and end of life care needs are recognised in all care settings, at times of diagnosis, at times of changing or complex needs, and at the end of life. Effective communication is essential to understand people's concerns and to provide them with information about their illness, prognosis and treatment options. Effective practitioners also support the psychological, emotional and spiritual well-being of the individual, their families and carers.

The Enriching and Improving experience framework developed by NES and SSSC can help you identify the knowledge and skills required by all workers who may provide care and support to people with palliative and end of life care needs, their families and carers. You can access the framework here.

You can download a copy of the Palliative and End-of-Life Care learning activities.

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Learning Activities
Support people with palliative and end of life care needs.

Recognising patients who have palliative and end of life care needs is important so they receive the level of care they need and that communication between professionals across health and social care settings is effective.

Review a sample of patients who have received care in your work place within the last month and identify which patients required palliative and end of life care. The following may be useful:
- What life-limiting condition are they suffering from?
- How did you recognise they were approaching end of life?
- What aspects of their treatment and care are considered to include palliative and end of life care elements?
- Are there any deficits in your knowledge and skills?
In collaboration with a work colleague, review the care provided to the patients and select someone who you consider has been provided with exemplary care.
- What aspects of care did you consider exemplary and why?
- Meet with someone in the team who you consider provided excellent care to the selected patient and discuss with them how this was achieved.
Ensuring patients can remain at home for as long as possible is highly desirable. In consultation with your colleague, discuss the resources that are available to support people at home?

Record your learning in your professional portfolio.

Related KSF core dimensions: personal and people development, quality.
Effective communication between health care professionals and patients, family and carers can be improved by establishing the needs of patients requiring palliative and end of life care. It is essential that practitioners are equipped with the relevant knowledge and skills. Patients and carers may find it difficult to tell us what matters to them and, in addition, health care professionals often find such emotional conversations difficult to establish and sustain.

Reflect on recent conversations with people requiring palliative and end of life care and identify which conversations you have found particularly difficult and why?

It will be helpful to identify situations where you feel your communication has had a positive or negative effect on the experience of a patient requiring palliative or end of life care.

Reflect and identify areas where you may need some development. These might include:
- Establishing rapport
- Being aware of the impact your non-verbal communication
- Beginning a dialogue with someone
- Exploring difficult issues with them such as their wishes and desires for their care as they approach death
- Using open and probing questions to establish their psychological well-being
- Providing information that is clearly understood.
It may be helpful to work with a colleague in a peer review context to provide mutual critique and support.

Select a colleague who you consider is an excellent communicator and identify what it is about their behaviours that makes a difference. Make arrangements to work with the selected colleague when they are communicating with a patient requiring palliative and end of life care; ensure you engage in dialogue with the patient.

Reflect on the activity in relation to the following:
- Describe the situation.
- What worked well in relation to your communication and your colleague's communication?
- What you would do differently the next time?
- Is there any development you require to improve your practice?
- What have you learned from this for your future practice?
Record your learning in your professional portfolio.

Related KSF core dimensions: communication and personal and people development.
Visit the ‘Caring for people in the last hours and days of life’ website and use the principles and areas of importance as a framework for reflection on the care for people in your clinical setting are cared for at this time.

Questions to consider in relation to a patient/client you have cared for at this time are:
- How did we perform in relation to the principles and specific areas of importance?
- What areas did we perform well in?
- What areas could we have done better in?
- How can we do this in future?
- What can we do to make this happen?
Record your learning in your professional portfolio.

Related KSF core dimensions: communication, quality, service improvement

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Reflection

Remember, recording your reflections is an important part of the learning process. Take time to structure your thoughts, feelings and any future actions on one the forms available in the Reflective Practice section. Click here to visit the page.

In your reflections you could also consider how your learning relates to the Facilitation of Learning, Leadership and Evidence, Research and Development pillars of practice.

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