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Rethinking priorities: experience of an educational initiative to change attitudes, behaviours and clinical practice in end-of-life care
  1. Annette Edwards1,
  2. Viv Barros D'Sa2 and
  3. Fiona Hicks3
    1. 1Leeds Teaching Hospitals NHS Trust and Sue Ryder Wheatfields Hospice, Leeds, UK
    2. 2Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
    3. 3Department of Palliative Care, Leeds Teaching Hospitals Trust, St James Hospital, Leeds, West Yorkshire, UK
    1. Correspondence to Dr Annette Edwards, Consultant in Palliative Medicine, Withybush General Hospital, Fishguard Road, Haverfordwest, Pembrokeshire SA61 2PZ, UK; annette.edwards3{at}wales.nhs.uk

    Abstract

    To implement the National End of Life Care strategy and enable more people to express and achieve their preferences about care at the end of life, senior clinicians outside palliative medicine need to make it a routine part of their practice. However, it is acknowledged that recognising that people are entering the last phase of their illness is not always straightforward, and having conversations about aims of treatment and planning for future care may not be easy. In order to begin to address these challenges, funding was sought from the Yorkshire and the Humber Strategic Health Authority (SHA), and subsequently Health Education England, Yorkshire and the Humber (HEEYH), to pilot a development programme in 2 acute trusts. 2 palliative medicine consultants shared the trainer role at each site, supporting hospital consultants from a range of specialties, with a GP to give a community perspective. The programme involved individual clinicians identifying their own learning needs and specific issues for end-of-life care in their patients. The group met together monthly in action learning sets to discuss issues in a safe yet challenging environment. Following evaluation using a combination of training needs analyses, feedback questionnaires, audits and service evaluations, it was modified slightly and repiloted in 2 further trusts as ‘Rethinking Priorities’. This paper describes the programme and its outcomes, especially in relation to participants' learning, service development and leadership. It also highlights the challenges, including different learning styles, the concept of action learning, obtaining funding and dedicated time, and how to evaluate the effectiveness of a programme. Overall, it suggests that an educational initiative based on clinicians identifying their own learning needs, and using an action learning approach to explore issues with other colleagues, with the addition of some targeted sessions, can result in positive change in knowledge, behaviour and clinical practice.

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    • Received 6 January 2017.
    • Revision received 22 February 2017.
    • Accepted 23 February 2017.
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    Footnotes

    • This paper is dedicated to Fiona Hicks who strove tirelessly to improve education in palliative care.

    • Collaborators Kathryn Winterburn, Laura McTague, Anne-Marie Carey, Ellie Smith.

    • Contributors FH had the initial idea for the educational initiative, and developed the programme. AE and VBDS have jointly written the paper, initially with FH. All acted as facilitators in the programme. Kathryn Winterburn is the Organisation Development lead for Health Education Yorkshire and the Humber, and was involved in the initial programme design, as well as leading Action Learning sets to support the facilitators. Dr Laura McTague, Dr Anne-Marie Carey and Dr Ellie Smith are consultants in Palliative Medicine who have facilitated the programme in Doncaster and Sheffield.

    • Funding Funding for the development programme was provided by the Yorkshire and Humber Strategic Health Authority (SHA), now Health Education Yorkshire and the Humber (HEYH).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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