Case study:

13 October 2011

Development of a communication prompt by East Lancashire Hospice

Key points

Developments were led by the End of Life Care Lead at East Lancashire Hospice in partnership with the Clinical Development Lead in the community team.

Initial prompts were used within hospice day therapy services. Feedback from professionals, day therapy patients, carer groups in the community, the Patient Advice and Liaison Service reader group and Asian community groups assisted in the final draft which was used for the pilot. Following requests the prompt was also translated into Urdu.

The pilot involved all community and hospice professionals, and some care home teams, being provided with a laminated copy of the tool, with access to the Urdu version.

They used this as applicable to support conversations with patients. The prompt was also used within Gold Standards Framework (GSF) education / support for care homes and at events to promote Dying Matters Week as poster versions.

An NHS Innovation grant of £2,202.25 enabled the design work, translation, printing and laminating of the prompt. Some admin costs were also funded from the grant.

The main challenges of the project included applying for the grant and subsequent reporting, along with obtaining written feedback from professionals.

Evaluation, although predominantly subjective, included monitoring of Preferred Priority for Care documents requested, advance care planning discussions completed (as identified at GSF meetings), questionnaires from professionals, comments from patient forum groups and comments from professionals at launch events.

Comments from patients have demonstrated that they do wish to have discussions of many issues which they consider important, whatever their cultural background or age etc. This was also reflected in comments from carers and patients in care home settings.

The prompt assisted professionals to initiate or support advance care planning discussions at earlier stages on some of the softer subjects such as food likes and dislikes, goals and ambitions, which could then more comfortably lead onto other more emotional topics.

Advance care planning and choice is a major element of care management and impacts on quality of life. If patients preferred priorities are known in advance this can support planning and management, which may lead to a more efficient use of resources.

The communication prompt itself is not a solution and end of life care is multifaceted. It simply contributes to supporting recommended best practices.