Whilst specialist palliative care services are fundamental to the delivery of high quality end of life care (EoLC), their educational role is also of paramount importance. Without broader knowledge and skills across the non-specialist work force the increasing global demands for EoLC cannot be met.
As non-specialist staff provide (with specialist support) the majority of EoLC, training of non-specialist staff is essential to ensure improvements in quality of care. To this end, a free 2-day course called Transforming End of Life Care (TEoLC) has been running at Guy’s and St Thomas’ NHS Foundation Trust since 2012. The course is designed to improve the EoLC knowledge and skills of multidisciplinary hospital and community staff.
The aims of the project are to evaluate and refine the existing Transforming End of Life Care course, to collect data to inform the development of new course material (e.g. extra modules for specific staff groups) and to determine the best way to assess the effectiveness of EoLC training for non-specialists in the future.
This is a mixed-methods study with four phases.
1. Systematic review of end of life care communication skills programmes for non-specialists
To learn from previous research in this field, we conducted a systematic review of end of life care communication skills training programs for generalist providers of palliative care. This review describes development, delivery, evaluation and reporting of these training programmes, and assesses their effectiveness in terms of patient reported outcomes and staff behaviours.
2. Evaluating the current Transforming End of Life Care course
The project began with a service evaluation using existing questionnaire data collected from course participants from 2012 to 2014. This demonstrated an immediate impact on confidence and knowledge in end of life care, including communication and teamwork:
- Selman, L., Robinson, V., Klass, L., Khan, S., George, R., Shepherd, K., Burman, R. & Koffman, J. (2015). Improving confidence and competence of healthcare professionals in end-of-life care: an evaluation of the ‘Transforming End of Life Care’course at an acute hospital trust. BMJ supportive & palliative care, 6:231-236.
Building on this work, TEoLC course participants were asked to complete questionnaires immediately before and after the training, and 3 and 6 months later. The questionnaires were used to evaluate the current course, and assess its impact on participants’ confidence and competence in relation to the course content.
We also held focus groups with people who attended the TEoLC course 3-9 months ago to explore the impact of training on practice, ask them about additional training needs and preferences, and explore the acceptability of different evaluation methods.
3. Exploring the training needs & preferences of GPs and hospital volunteers
To explore training needs and preferences, and acceptable ways to evaluate such training, we conducted focus groups with two groups of care providers:
- Selman, LE., Brighton, LJ., Robinson, V., George, R., Khan, SA., Burman, R., & Koffman, J. (2017). Primary care physicians' educational needs and learning preferences in end of life care: A focus group study in the UK. BMC Palliative Care. doi: 10.1186/s12904-017-0191-2
- Brighton, LJ., Koffman, J., Robinson, V., Khan, SA., George, R., Burman, R., & Selman, LE. (2017). “End of life could be on any ward really”: A qualitative study of hospital volunteers’ end of life care training needs and learning preferences. Palliative Medicine. doi:10.1177/0269216316679929.
4. Determining the feasibility, appropriateness & acceptability of methods to test training effectiveness
In the Phase 2 and 3 focus groups we explored participant views of different methods of assessing the impact of training on staff, patient and family outcomes. In addition, based on Phases 1-3, a selection of potential measures to assess training effectiveness were tested in cognitive interviews with staff, patients and family members. This will allowed us to assess the feasibility, appropriateness and acceptability of different measures to test training effectiveness.