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Palliative care clinicians' knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS)
  1. Caroline Barry1,
  2. Anna Spathis2,
  3. Sarah Treaddell3,
  4. Sally Carding4 and
  5. Stephen Barclay5
  1. 1 Norfolk and Norwich University Hospital, Norwich, UK
  2. 2 Palliative Care Team, Addenbrooke's Hospital, Cambridge, UK
  3. 3 Arthur Rank House, Cambridge, UK
  4. 4 Palliative Care Team, Hinchingbrooke Hospital, Huntingdon, UK
  5. 5 Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Caroline Barry, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; Caroline.barry2{at}


Objectives To examine palliative care clinicians' level of knowledge of the law regarding the use of the Deprivation of Liberty Safeguards (DoLS).

Methods Regional postal survey of palliative care clinicians working in hospices in the East of England, undertaken in April 2015. Clinicians' level of knowledge was assessed by their response to 7 factual questions. Data regarding self-reported levels of confidence in applying the Safeguards was collected, alongside information regarding the number of times they had used DoLS in practice. A free-text section invited additional comments from participants.

Results There were 47 responses from 14 different organisations; a response rate of 68%. Respondents included consultants, specialty and associate specialists, registrars, nurses and social workers. Higher self-reported confidence and training in the use of DoLS was associated with higher factual knowledge. Consultants had the highest level of knowledge, training and experience. Doctors of other grades, nurses and social workers recorded less knowledge and experience and scored lower in the knowledge sections. The free-text comments revealed difficulty applying the Safeguards in practice, particularly among the consultant responses, based around several themes: insufficient guidance on how to use the Safeguards, process after death, uncertainty as to relevance to palliative care and delays in assessments.

Conclusions Clinicians working in palliative care have good levels of knowledge of the DoLS. Despite this concerns were raised, particularly by consultants; uncertainty as to when they should be used and the relevance of the Safeguards in clinical practice. Further guidance should be given to clinicians working in this specialty to ensure that clinical practice is both lawful and in the patients' best interests.

  • Clinical decisions
  • Ethics
  • Hospice care
  • Education and training

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  • Contributors CB conceptualised the study and wrote the paper. Survey was conducted by CB, ST and SC. CB, ST, SC, AS and SB were all involved in data analysis and interpretation. AS and SB provided critical review throughout the study. All authors have read and approved the final version of the paper.

  • Competing interests None declared.

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