Abstract

The Serious Illness Conversations Cymru project was initiated in response to the Welsh Government’s Palliative and End of Life Care Delivery Plan (2017) which places developing skills such as serious illness conversational skills as an essential part of upskilling generalists in palliative care.

This article describes the delivery, outcomes and potential impact of the Serious Illness Conversations Cymru project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18 month period in excess of 360 front-line Welsh ambulance staff attended 4 hours of face-to-face teaching, to include serious illness conversation/communication skills; symptom control at the end of life and ‘shared decision making’. Mixed methodology outcomes, in terms of quantitative and qualitative data were collated and analysed to gain both insight as to how WAST staff view themselves within the context of end of life care and the impact of the teaching on their confidence and the wider service.

Qualitative outcomes indicate WAST staff view themselves in several important and necessary roles, acting as ‘facilitators’ to patient centred, seamless care. The difficult questions and situations pertaining to end of life care were largely around patient death and dying, and the expectations of those involved. Quantitative outcomes of six communication domains indicate there was a statistically significant improvement in self-assessed confidence. The overall impact to the wider ambulance service indicates a trend toward increased conveyancing of patients to alternative settings rather than to A and E, increased administration of injectable medicines for end of life care by ambulance service staff and better use of resources such as increased attendance of a rapid response vehicle only as an alternative to an ambulance.