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Milestones: a mixed methods study of an educational intervention to improve care of the dying
  1. Michelle Mooney1,2,
  2. Rebecca Bright2,3,
  3. Victoria Vickerstaff2,4,
  4. Caroline Stirling2,5 and
  5. Sarah Yardley2,4,5
  1. 1Ruby Ward, Newham Centre for Mental Health, London, London, UK
  2. 2UCLPartners, London, UK
  3. 3Pilgrims Hospice Thanet, Margate, Kent, UK
  4. 4Marie Curie Palliative Care Research Department, University College London, London, UK
  5. 5Camden, Islington, UCLH & HCA Palliative Care Service, Central & North West London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sarah Yardley, Palliative Care, Central & North West London NHS Foundation Trust, 149 Tottenham Court Rd, Bloomsbury, W1T 7NF, London, UK; sarahyardley{at}


Background Approximately 460 000 people die annually in England. Three-quarters of these deaths are expected. Health Education England is prioritising upskilling of clinical staff in response to reports of poor care quality in the last days of life in acute hospitals, where almost half of all deaths occur. This study explores the impact of an end-of-life care (EoLC) educational intervention, Milestones, in acute hospital trusts in Greater London.

Methods This is a mixed methods study. Learners completed a questionnaire pre- (n=452), immediately post- (n=488) and 3 to 8 months post- (n=37) intervention. The questionnaire measured learner confidence in EoLC covering the National Health Service adopted ‘Priorities for the Care of the Dying Person’. Paired t-tests were used to determine statistically significant difference in learner confidence pre- and post-intervention. A convenience sample of learners (n=7) and educators (n=5) were recruited to qualitative semi-structured interviews that sought to understand if, how and why Milestones worked. Data were analysed using a thematic approach.

Results A statistically significant increase in learner confidence across all five priorities of care’ was sustained up to 8 months (p<0.001). Interviewees wanted to discuss wider challenges in EoLC related to the organisations and cultural contexts in which they worked. Concerns included balancing hope when decision-making, learning as a multidisciplinary team and emotional impact.

Conclusion The findings suggest that Milestones is a flexible, beneficial resource for teaching EoLC that facilitates enhanced learner engagement. Understanding generated about wider concerns can inform future educational material development, organisational process and research study design.

  • education and training
  • hospital care
  • terminal care

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  • Contributors MM, RB, VV, CS and SY all contributed to the design, conduction, analysis and interpretation of this study and to the creation of this manuscript, including approval of submitted version. CS and SY are the guarantors of the work.

  • Funding The work was funded by UCLPartners and Health Education England (North Central and East London). MM reports grants and other funding from Health Education England during the conduct of the study. RB reports grants from Health Education England during the conduct of the study; personal fees from Health Education England, outside the submitted work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The original data for this study is held by UCLPartners ( Milestones film and associated materials are available to download from: