Background ACP is a key means of improving care for people nearing the end of life. Enables better planning and provision of appropriate care (End of Life Care Programme, 2008). Although recognised as important, ACP conversations are not always carried out, confirmed by baseline audit (2015) of ACPs by patients with brain tumours. Results suggested some ACP occurring but scope to improve.
Methods Exploratory study to consider attitudes, enablers and possible barriers for hospice staff engaging in ACP. Need for good understanding of ACP and assistance with communication skills highlighted.
Following study, ACP Steering Group formed, actions included:
• ACP workshops for clinical staff.
• Review of an appropriate ACP paper document for patients to supplement oral information.
• New ACP template for hospice electronic records.
5×2 hour, at hospice, attended by hospice MDT (March –September, 2016). Consisted of presentation covering various aspects of ACP then time allowing staff opportunity to practice communication in role-play using ‘fish bowl’ technique.
Doctors (4), IPU nurses (9), CNS (community) (9) Pharmacy (4), Day Hospice (3), MDT (4) Administrator (1)
100% attendees: workshop met training needs, most appreciated ‘fish bowl’ exercise some requested additional training most requested further opportunities to practice challenging conversations. Feedback on new electronic template: allows clear recording, easy to find recorded conversations, raises ACP profile. Follow up ACP audits: December 2016, April 2017. Results include 95% patient records: evidence of complex discussions about ACP with hospice HCPs. Given the popularity of experiential training and recognising the need to assist staff with communication, further communication skills workshops arranged. Feedback: assist in increasing confidence and skills in addressing challenging conversations including ACP discussions.
Conclusion Hospice staff need training and support with ACP. Understanding and addressing needs in a variety of methods results in both an increase of ACP conversations and more confident staff.
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