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Lived experiences of the palliative care journey

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https://elearning.rcgp.org.uk/mod/book/view.php?id=12529&chapterid=273

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Training resources to help fulfil CPD and revalidation requirements.

Further study and learning modules for practitioners

As well as reflective practice within local palliative care meetings, such as a practice Gold Standards Framework (GSF) meeting, clinicians are also able to access study days, online learning modules and post-graduate qualifications.

Autism Spectrum Conditions: end of life care and accessing healthcare services

A YouTube guide for clinicians made in partnership with Marie Curie.

Audit

Clinicians and practices may carry out their own audits as part of the GSF meetings and to fulfil their Care Quality Commission obligations. Online tools are also available to help meet this requirement.

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end of life and palliative care toolkit: training and appraisal

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End of life and palliative care toolkit: Training and appraisal

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Training resources to help fulfil CPD and revalidation requirements. As well as reflective practice within local palliative care meetings, such as a practice Gold Standards Framework (GSF) meeting, clinicians are also able to access study days, online learning modules and post-graduate qualifications. A YouTube guide for clinicians made in partnership with Marie Curie.

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Toolkit for healthcare professionals to support patients nearing the end of life to live well until they die.

Approximately 1% of the UK’s population die each year, and within that population the majority of deaths can be predicted. Evidence has found that early identification of patients who are likely to die within the next 12 months often enables well coordinated, pro-active quality care, and allows healthcare professionals to focus on better meeting patients’ needs. It has been developed in partnership with Marie Curie and the Clinical Innovation and Research Centre.

The End of Life and Palliative Care Toolkit provides a collection of tools, knowledge, and current guidance for healthcare professionals to support patients nearing the end of life to live well until they die. The resources include information for patients and those close to them.

Who is the End of Life and Palliative Care Toolkit for?

Any general practice in the UK can use the toolkit. The resources are for healthcare professionals, informal carers, patients and those close to them.

For resources related to end of life care and COVID-19, visit the dedicated section on our COVID-19 Resource Hub.

The toolkit will be updated on a regular basis. Please send any comments or suggestions to clinicalquality@rcgp.org.uk

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End of life and palliative care toolkit: Introduction

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Toolkit for healthcare professionals to support patients nearing the end of life to live well until they die.

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Background There is a need for expanded end-of-life (EOL) care education and resources for health professionals in acute hospitals to help them increase EOL care skills and knowledge, and build capacity and confidence to provide high-quality EOL care. End-of-Life Essentials (EOLE) is an Australian government-funded project, which offers free peer-reviewed online education modules and implementation resources on EOL care to health professionals in acute hospitals, aiming to help support the provision of high-quality EOL care.

Methods The development of EOLE education modules included seven major steps and two peer-review processes. In total, ten EOLE education modules and associated toolkits had been developed by the end of 2018. To evaluate the effectiveness of EOLE education modules, premodule and postmodule survey data from all ten modules and registration data were extracted from the EOLE learning management system for a 4-month period. The significance of difference in learners' self-perceived EOL care knowledge, skills, attitude and confidence before and after module learning were tested by Wilcoxon Signed Ranks Tests.

Results Results from Wilcoxon Signed Ranks Tests revealed statistically significant improvement in learners' self-perceived EOL care knowledge, skill, attitude and confidence after completion of EOLE modules regardless of their discipline (p<0.001). The learners from different disciplines also reported a high level of intention (median=4, IQR=1) to change their practice after completion of EOLE module learning.

Conclusion The evaluation results show a positive impact of EOLE module learning on allied health professionals, doctors and nurses, suggesting that EOLE could be a reliable and accessible online EOL care education resources for health professionals of all disciplines to improve their EOL care knowledge, skills and confidence, build up their capacities in providing quality EOL care to patients and their families, in turn, improve the quality and safety of EOL care in health settings.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Development of EOLE education modules

Ten EOLE education modules had been developed by the end of 2018 (see table 1), covering three main categories: (1) understanding death and dying; (2) clinical skills in EOL care such as recognising the end of life, patient-centred communication and shared decision-making, planning EOL care; and (3) EOL care with different patients such as patients living with chronic complex illness, paediatric patients and patients in emergency department. 15

The strengths of this project include: (1)the EOLE education modules and Implementation Toolkits were built around areas of knowledge gap identified in the ACSQHC's National Consensus Statement: essential elements for safe and high-quality EOL care. 14 (2) The rigorous process of education module development (see figure 1). From the inception of EOLE, quality, consultation and industry partnership have been paramount. A peer-review process was devised to ensure the quality and relevance of educational materials, and the quality of user experience was also an important focus. (3) Metacognition was employed as the underpinning framework for the education design, an approach encouraging learners to critically reflect on their practice. 16 Studies showed that utilisation of metacognitive strategies in online learning environment may contribute to better learning engagement and performance. 16 17

Quizzes, videos and clinical practice-related open-ended questions were embedded in modules to prompt critical thinking and self-reflection, activities that are user friendly and easy to access. Downloadable Implementation Toolkits were developed to facilitate clinical practice change 18; EOLE education modules also emphasise compassionate care (using scenarios for context), which is fundamental to EOL care 19 and promotes HCPs self-care.

Evaluation of EOLE education modules

Ongoing EOLE module evaluation is embedded in a learning management system (LMS), including pre-evaluation/postevaluation surveys consistent across all modules and individualised free-text questions asking learners about their clinical practice. 20 This multimethods approach allows breadth and depth of module evaluation. 21 As the aim of this paper is to evaluate the changes of learners' self-perceived EOL care knowledge, skills, attitude and confidence after completion of the modules, the pre-evaluation/postevaluation methods will be described.

The pre-evaluation and postevaluation questions were developed based on Kirkpatrick's Model of evaluation, 22 in which four levels of learning outcome were assessed, including: '(1) reaction, (2) learning, (3) behaviour and (4) results'. 22 The pre-evaluation/postevaluation questions are specific to the context of each module (eg, pre: in thinking about providing EOL care for patients living with chronic complex illness/post: since completing this module, in thinking about providing EOL care for patients with chronic complex illness 20).

In the pre-post evaluation, all modules include four identical statements about EOL care knowledge, skill, attitude and confidence. There is also a postevaluation statement "I intend to change my practice in end-of-life care", aiming to explore the impact of EOLE module learning on learners' intention to change their practice. Learners are asked to select 'strongly disagree', 'disagree', 'neutral', 'agree' or 'strongly agree' for each of the statements in a simple five-point Likert scale, with '1=strongly disagree' and '5=strongly agree'. 20

Data analyses were conducted using IBM SPSS V.25.00. The combined scores of self-perceived EOL care knowledge, skills, attitude, confidence and intention to change practice were calculated as average out of modules undertaken by learners (maximum 10 modules). The higher scores indicated higher level of self-perceived EOL care knowledge, skills, attitude, confidence and intention to practice change. A value of p<0.05 was considered statistically significant. Descriptive statistics were summarised as frequency with percentage for demographic variables. The significance of difference in learners' self-perceived EOL care knowledge, skills, attitude and confidence before and after module learning were tested by Wilcoxon Signed Ranks Tests as data were not normally distributed, these tests were undertaken for the entire learner group and each health professional group separately. Median and IQR typically reported for non-normally distributed data were provided. Furthermore, to explain the change across the time, the means were also listed. Effect size (r=z/ ) was calculated based on the method recommended by Fritz et al 24 and Pallant, 25 0.5 was deemed a large effect, 0.3 was deemed a medium effect and 0.1 was deemed as a small effect. 24 95% CIs of the effect size were calculated via the calculator online. 26

Impact of module learning on learners' self-perceived EOL care knowledge, skills, attitude and confidence

Wilcoxon Signed Ranks Tests revealed statistically significant improvement in learners' self-perceived EOL care knowledge, skill, attitude and confidence after completion of EOLE modules regardless their disciplines(p<0.001). The effect size of improvement in self-perceived EOL care knowledge, skills and confidence ranged from 0.36 to 0.53, demonstrating a medium to large effect and the effect size of improvement in self-perceived EOL care attitude ranged from 0.28 to 0.37, showing a small-to-medium effect ( table 2).

Impact on intention to practice change

Overall, learners who completed at least one of the intention to practice change postevaluation question of the modules (maximum 10 modules) (n=1478) reported a high level of intention (median=4, IQR=1) to change their practice after completion of EOLE module learning, regardless of their discipline, with level of intention to practice change from allied health professionals (n=196, median=4, IQR=1), doctors (n=178, median=4, IQR=1) and nurses (n=1104, median=4, IQR=1).

Discussion

Evaluation results showed that EOLE learners were HCPs from different disciplines, including allied health professionals, doctors and nurses, although the majority were nurses. Learners were from Australia and other countries, showing that EOLE was an accessible online course for HCPs. EOLE online education modules allow a flexible, self-paced way for HCPs to update their EOL care knowledge and skills based on their individual needs. This online learning style is particularly important during the current pandemic environment where the traditional face-to-face training might be challenging and the demand for EOL care knowledge and skills have increased. 27

Evaluation results indicated a positive impact on learners' self-perceived EOL care knowledge, skill, attitude and confidence after completion of EOLE modules, which may help HCPs build their capacity in providing quality EOL care in hospitals. 10 28 Module learning also prompted HCPs' intention to change their clinical practice, with intent considered a predictor for behaviour change. 29 These results further support the positive impact of EOLE module learning. 4 20 30 More importantly, addressing the aim of this evaluation, learners from these varied disciplines demonstrated statistically significant improvement of self-perceived EOL care knowledge, skills, attitude and confidence, and reported a high level of intention to change their practice after completion of the module learning, suggesting that all HCPs could benefit from EOLE education regardless of their discipline. These results demonstrated the suitability of EOLE education modules for all HCPs as a quality education course which are consistent with the scope and aim of EOLE project. Having said that, the degree of benefit gained by allied health professionals and doctors should be considered cautiously due to the small sample size compared with the nurses. Future studies are needed to further explore the effectiveness of module learning on these two groups.

There are some limitations to this study. There was a lack of demographics details such as age, gender, years of experience in EOL care due to the limited capacity of the data collection platform (LMS). The nature of voluntary participation might contribute to selection bias, as the perspectives of non-responders to the evaluation components might be different. 20 31 Again, evaluation questions were self-perceived, which may not reflect the objective changes. 32 To also note is that the learning objectives for each education module were not specified, nor drawn out in the evaluation. The evaluation questions are standardised across the different modules and not designed for each of the learning objectives in individual modules. The advantage of this approach is that the education module could be evaluated broadly in a similar way, while the disadvantage is that the evaluation does not breakdown to focus on the nuance of individual modules. Furthermore, we acknowledge that the positive impact of education itself may not reflect the improvement of actual clinical practice. 33 An ongoing longitudinal study is in progress to further investigate the influence of EOLE education module in clinicians' clinical practice.

Patient consent for publication

Not applicable.

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End-of-Life Essentials education modules: a quality and safety initiative to improve health professionals end-of-life care knowledge, skills, attitude and confidence

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Background There is a need for expanded end-of-life (EOL) care education and resources for health professionals in acute hospitals to help them increase EOL care skills and knowledge, and build capacity and confidence to provide high-quality EOL care.

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Breaking Bad News - Role Play/Actors in pairs eg  (hospice resources/scripts) - https://www.bradfordvts.co.uk/communication-skills/breaking-bad-news/?utm_content=cmp-true 2. Perform a search in your practice to establish what % of the practice list have end of life / ACP / chair a Palliative Meeting 

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Breaking Bad News - Role Play/Actors in pairs eg  (hospice resources/scripts) - https://www.bradfordvts.co.uk/communication-skills/breaking-bad-news/?utm_content=cmp-true 2. Perform a search in your practice to establish what % of the practice list have end of life / ACP / chair a Palliative Meeting 

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Bradford VTS Online Resources Consultation Skills Breaking Bad News DOWNLOADS WEBLINKS If you have files you would like me to host on here and share with others, please email them to me. rameshmehay@googlemail.co.uk Breaking bad news is a core microskill for any doctor At some point or another, all doctors have to break bad ...

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Cancer UK Gateway C Palliative Care for Cancer Patients

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Cancer UK Gateway C Palliative Care for Cancer Patients

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https://event.on24.com/wcc/r/3038978/BFF62A5FE643ACFCA70CAAB0CD6AAD68

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Wednesday, March 31, 2021 at 1:00 PM British Summer Time.

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What is my local "Just in case" drug chart system?

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What is my local "Just in case" drug chart system?

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How do you prescribe them?
What are the recommended starting and ongoing doses in your local LICS?
Where can you seek help for difficult problems outside the framework of that system?

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What number and what types of palliative care patients are currently being looked after by your practice?

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What number and what types of palliative care patients are currently being looked after by your practice?

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What local services exist for End of life care for Out Of Hours patients?

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What local services exist for End of life care for Out Of Hours patients?

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How does End Of Life care vary between cancer patients and non-cancer patients?

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How does End Of Life care vary between cancer patients and non-cancer patients?

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Prompts - Come prepared to discuss what you found out about ..... (set a question) 'How is palliative care organised in your practice) - > Quality Improvement Project .... 2. Discuss what you learnt about ... using a syringe driver/advanced directives 

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Prompts - Come prepared to discuss what you found out about ..... (set a question) 'How is palliative care organised in your practice) - > Quality Improvement Project .... 2. Discuss what you learnt about ... using a syringe driver/advanced directives 

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Could protocols on EMIS / templates on SystmOne improve prescibing processes?
Is ReSPECT being implemented/future care planning being consistently well-discussed?

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Does everyone  have a DNACPR/ReSPECT form that's valid?
Are preferences after death being recorded and taken into account?
Is prescribing of palliative care meds meeting standards?

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Together - collaborate to design a practice protocol for dealing with a request from a patient who is end of life / JIC meds 

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Together - collaborate to design a practice protocol for dealing with a request from a patient who is end of life / JIC meds 

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1) About a patient you've met
2) About your knowledge of prescribing
3) About advance care planning

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Find out if your practice has any SEA involving palliative care/patient at end of life and write the report that responds to the SEA/complaint

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Find out if your practice has any SEA involving palliative care/patient at end of life and write the report that responds to the SEA/complaint

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and getting feedback from it

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Make a map of the different organisations mangaing palliative care for communtiy patients and the roles of each one.

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Make a map of the different organisations mangaing palliative care for communtiy patients and the roles of each one.

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Who gets admitted to your local hospice? How does that happen? Who can't be admitted to a hospice and why?

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Who gets admitted to your local hospice? How does that happen? Who can't be admitted to a hospice and why?