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Changing end of life care

2015 Palliative Care Team of the Year

Interview with Dr. Andrew Daley, a consultant in palliative medicine at the Palliative Care Managed Clinical Network in Bradford.

"We’ve shown that if you’re prepared to put the effort into collaborating you can achieve great things together." - Dr. Andrew Daley

Palliative care is widely available to people with cancer, however malignancy is only responsible for about one in four deaths in this country. The majority of people, dying from other conditions, are far less likely to have access to good palliative care. In the Bradford area, less than 30% of referrals to the specialist palliative care services are for non-malignant conditions.

With this in mind, the Palliative Care Managed Clinical Network developed an innovative approach to providing end-of-life care for all patients. The Bradford, Airedale, Wharfedale and Craven (BAWC) Last Year of Life project won the Palliative Care Team of the Year award at this year’s The BMJ Awards. This is their story.

Improving-01

Led by Dr. Andrew Daley, BAWC Last Year of Life works by training staff to provide consultations, recording these conversations in a shared electronic record system, and creating Goldline: a 24-hour telephone nursing line for patients. The project provides training for healthcare workers and gives them the necessary skills to have sensitive discussions around a patient’s end of life decisions. This type of training is important because many healthcare professionals feel uncomfortable discussing this area or have limited time to be able to sit down and have sensitive talks. The project’s training also emphasises the need to have conversations when the patient is with their GP or at the hospital, instead of when a out-of-hours crisis happens.

“The challenge for GPs and district nurses is that doing this well takes a lot of time. You need to sit down and talk though these things carefully and sensitively.” – Dr. Andrew Daley

Once these conversations occur the project helps to document them in an electronic format that is retrievable and accessible to staff. Templates facilitate and guide staff through the whole process of adding information to the patient’s clinical record, and also includes printable information leaflets for families. Convincing nurses, doctors and hospital staff to collaborate is a long process, but “you don’t change the world overnight” says Dr. Daley.

Lastly, the project established an advice line staffed with trained nurses for patients and families to access out of hours. Goldline, the 24-hour nursing line for patients, was created after frustrations over using general call centres with untrained staff. Dr. Daley states, “many people in the health services recognize that out of hours care is a problem and so frightening for patients and families.”

Patients-Values Circle

The benefits of Goldline is that nurses have access to the patient’s clinical record, and therefore the patient doesn’t have to relay their entire story over the phone. In addition, about 40% of the calls are handled by the nurses, and there isn’t a need for an ambulance to be dispatched. Alternatively, the nurse will arrange for an out of hours doctor or district nurse to visit, depending on which they judge most appropriate. Goldline provides patients and their families with ease of use (only one number to call) and peace of mind (with trained staff ready at any time of day). Qualitative data from interviews with patients and carers corroborates this. Interviews show “they value the service and it makes their quality of care feel so much better” according to Dr. Daley.

Future plans for the BAWC Last Year of Life Project include expanding Goldline. Dr. Daley states, “we wanted to think of how we can extend good care to people with other conditions beyond cancer. We would very much like to see Goldline extended into other patient groups, such as people with long-term conditions, for example, heart disease and dementia.”

BMJ Winners Last Year of Life 72dpi

Receiving the 2015 award from The BMJ “has been a great boost to our morale. We see it as a recognition of the benefits of services trusting each other, making the effort to communicate, and working together. We’ve shown that if you’re prepared to put the effort into collaborating you can achieve great things together” says Dr. Daley.