Background Unregistered health and social care workers arguably provide the bulk of end of life care. They spend more time with people than trained staff, undertake more personal care and are often seen as the closest ally and friend by the people who may entrust them with unique confidences and share fears and hopes. Eleven support workers taking a 2 year foundation degree in palliative and supportive care participated in an evaluation study. Communication skills training including role play was embedded in two modules.

Methods Mixed quantitative and qualitative methods were used at 4 time points over 2 years. Responses to the FATCODb, meaninglessness questionnaire and PERT self assessment of efficacy were analysed descriptively and interviews thematically.

Results Confidence increased in responding to a patient who says ‘I can see no meaning in life’ for those who felt unconfident in this at the start of the degree. Although some still reported ‘feeling uncomfortable talking about impending death with the dying person’ there was decreased agreement with ‘I would feel uncomfortable if I entered the room of a terminally ill person and found him/her crying’. The median score for self evaluated effectiveness in communicating with patients with advanced and terminal illness and their families increased from 5 to 8.5 on an 11 point scale. Interviews identified much greater confidence in working with communication scenarios that students previously would have found challenging and would have avoided or disengaged with. Use of silence was a key new strategy.

Conclusion Students felt more able to deal with challenging situations and self-reflective as well as externally reported practice indicated a greater competence in key end of life communication tasks. Students identified the pivotal importance of confidence and competence in communication which underpinned the outcomes for all aspects of end of life care.