Approximately 89.6% of patients‘ who are going to die in the next 12 months are admitted to hospital at least once. Evidence shows that good communication reduces hospital stays through advance care planning in the last 12 months of life. End of Life and DNAR discussions are part of the F2 curriculum and the development of good communication skills is a central part of clinical training. It is important to note that it is now a legal requirement that doctors involve patients and families in decisions regarding treatment escalation and resuscitation following the Tracey Judgement.
A recent audit undertaken at our Trust showed that there is scope for improving the quality of treatment escalation conversations the doctors are having with patients and their families as well as the documentation of these discussions.
An initial survey of F2 doctors showed that 92% had previously had TEP discussions with a patient, 77% with a relative and 69% had completed a TEP form. 46% reported not feeling confident having these discussions with main concerns not knowing what to say to initiate the conversation, being unable to answer questions and causing distress to both the patients and their family
A SIM course was delivered to improve the communication skills and confidence of F2 doctors allowing them to practice with actors in a safe learning environment. This learning was consolidated by debriefing with consultants in geriatric and palliative medicine. Post course feedback showed all participants enjoyed the course, 90% found it useful for clinical practice and 80% would recommend it to their colleagues. Significantly, all participants feel confident in discussing TEP following the SIM and commented on the detailed feedback.
This should lead to an increase in the number of patients who have these documented discussions which we know improves patient care.
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