Background Clear and thoughtful discussion around advanced illness is paramount. Healthcare professionals are legally required to involve patients and families in decisions regarding treatment escalation and resuscitation. Forms used to document such conversations could only be completed by doctors in our Hospital. This project introduced an effective programme enabling non-medical clinicians from a variety of backgrounds to complete treatment escalation plan (TEP) forms.

Method

1. Gauge opinions of professionals in the Trust.

2. Develop training day equipping clinicians with the knowledge, skills and confidence to have discussions with patients and their loved ones.

3. Develop competency-based programme including supervised conversations and reflections for candidates who have successfully completed the training day.

Results Training day run by TEP lead and Palliative Care team including lectures and simulation-based communication skills with a professional actor covering scenarios reflecting diversity of candidates. All candidates had ‘satisfactory to continue’ outcome. Confidence communicating with patients and families increased 100%. All lecture sessions rated as good or excellent. Despite initial nerves, all candidates rated simulation session as ‘excellent’. Candidates progressed to complete a competency based programme. Service evaluation feedback obtained from patients/families via telephone following consultations with candidates. Feedback confirmed a desire among patients and relatives to have these conversations and candidates’ experience, alongside the training day equipped them well to carry these clearly and compassionately.

Conclusions This was a successful introduction of a new Trust approved policy with positive feedback from candidates, patients and relatives. There have been a further 4 courses with diverse participants from primary and secondary care, including nursing homes and community teams. All courses oversubscribed. Next steps are to expand training programme across the region.