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Doctors call for better training in end-of-life care

BMA report calls for improved communication between doctors, patients and families

Mark Gould

Monday, 14 March 2016

A major report by the British Medical Association reveals that while there are examples of excellent end-of-life care across the UK, there is too much variation between geographic areas and between medical conditions.

The report, End-of-life care and physician-assisted dying, which drew on the views of 237 doctors and 269 members of the public, calls for wide-ranging changes to how the NHS handles end-of-life care to ensure every patient has “a good death”.

It identified a series of flaws in care for those nearing the end of their lives and says there is an urgent need to ensure the provision of consistently high-quality end-of-life care, for ongoing education, training and support for doctors and, that families and those close to the patient take a more central role in decisions about care and treatment. It wants doctors to be trained to "encourage and accept" when patients are nearing the end of their lives without viewing this as a failure.

The BMA says the report sets the agenda for its future work and policy development in these areas and hopes that it will "serve as a basis for discussion and action, among both members and stakeholders".

The report identified a series of shortcoming and flaws including:

  • Patients spending their last days being looked after by relatives can suffer when they encounter “long delays in getting appropriate pain medication out of hours”.
  • Doctors need to be better at identifying patients who are dying as a way of ensuring that they do not end their lives in hospital when they would rather be at home.
  • While patients with cancer often get good end-of-life care, more must be done to help those with other illnesses, especially chronic obstructive breathing disease.
  • Doctors need more training to help them handle “difficult conversations” with dying patients and their relatives about the inevitability of death and be more confident in such exchanges.
  • The inadequacy of social care means some patients die in hospital because the local council cannot put in place arrangements to allow them to be safely discharged home.
  • Health professionals can be so busy that they do not always treat patients’ relatives with kindness. To some bereaved family members, such support “can often seem a low priority for already overstretched staff”.

In response, NHS England said care could be better. “A recent survey found that three-quarters of bereaved people rate the overall quality of end-of-life care for their relative as good or better. But we know that there are variations in the care and services that people receive and we want to continue improving people’s experience of care, including relieving symptoms such as pain,” a spokesman said.

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