The National Institute for Health and Care Excellence (NICE) recommends integration of haematology and specialist palliative care (SPC) services in haematological malignancies, including SPC representation on the multidisciplinary team (MDT) (NICE 2003,Improving outcomes in haematological cancers: the manual, NICE, London). However, systematic reviews and meta-analyses reveal that patients with haematological malignancies are half as likely to receive SPC input as those with other cancers, and twice as likely to die in hospital, where death is associated with lack of SPC referral (Howell et al. 2014, ‘Variations in SPC referrals...’,BMJ Supportive and Palliative Care; 0: 1–7). Might these findings relate to gaps in palliative care education within haematology specialty training?
To address this, four first-year haematology trainees were offered placements at the local hospice. Their programme included: the Inpatient Unit (MDT meetings, ward rounds, tutorials, observing SPC doctors consulting and admitting patients for symptom control, respite and terminal care); Day-patient Unit; Family Support Team; Chaplaincy; and community work (accompanying Nurse Specialists at caseload reviews, home visits and GP surgeries).
Pre- and post-placement, the trainees rated their ability to: break bad news; empathise with patients; provide symptom control; and discuss prognosis with relatives. For each trainee, confidence in each skill-set improved. Individual learning objectives were co-constructed with the lead clinician and reviewed post-placement. Each trainee wrote post-placement reflections on personal and professional perspectives of care. Theserevealed insights into barriers to referral from haematology to SPC services, and ways of overcoming these.
Although palliative care lies within the JRCPTB haematology syllabus,with evidence of engagement through case based discussions and mini-clinical evaluation exercises requested, these were electronically impossible to upload until this work was presented. We highlight current gaps in palliative care education within haematology training, and recommend that formal palliative care education through hospice placements may enhance patient outcomes and experiences in haematological malignancies.
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