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BMA calls for improvements to end of life care in final volume of research project

Author: Tom Moran
14 March 2016
  • Patient in hospital bed, Dr taking pulse

The British Medical Association (BMA) has published a third and final report in its investigation into end of life care in the UK, with recommendations on how to improve the services currently being offered.

Today’s report is the culmination of a project launched in 2014 that sought to understand attitudes – both those of medical professionals and the general public – towards end of life care. The first two reports in the project were published in January this year.

Doctors and other healthcare professionals identified four areas in which end of life care currently faces difficulties: medical services, locations, communication and coordination of care. Chief among these worries was the finding that doctors often treat dying people for longer than was medically necessary.

The report also found that some doctors may see end of life care as a failure, and that end of life care often begins too late. Existing failings were particularly true for patients with a non-cancer diagnosis, with doctors generally of the opinion that cancer care tends to work well.

It was also recognised that hospices provide the "gold standard" in end of life care, but concerns over the availability of hospice beds remain. Additionally, many healthcare professionals still found it difficult to talk to patients about death and dying.

The report grouped its findings into three key areas: the need for consistent, high quality care, better access for medical professionals to education and training, and the involvement of families and others close to patients.

"There is a clear desire amongst doctors to have better support and training to help improve the care they can offer patients at the end of their lives," Dr Ian Wilson, the project and steering group chair, wrote in his foreword to the report.

However, he added: "Both doctors and the public recognise the pressures on doctors’ time, and that the communication and coordination on which the best examples of practice so depend are too often constrained by conflicting demands on that time."

Responding to the report, Dr Ros Taylor, clinical director at Hospice UK, said: "This report by the BMA highlights the pressures faced by doctors to prolong medical treatment for dying people after the point when it provides any benefit. This is often due to a lack of confidence of many doctors to have meaningful conversations about the goals of care and what matters to people.

"Compassionate and honest communication with patients and their families lies at the heart of good care and more doctors need to be given the right support and training to explore options of care that add life to days, rather than days to life.

"The need for training for doctors has been highlighted in numerous other reports, and until there is action on this issue, sadly more dying people and their families will be let down by the healthcare system just when they need it most.

"Hospices have considerable expertise and experience in care, decision-making and difficult conversations and can offer education and placements to doctors. Many hospices are already working in partnerships with local hospitals to share their culture of compassionate care but more hospitals and GPs needs to engage in this work."

Both NHS England and the Department of Health also conceded that there was significant room for improvement in end of life care.

"A recent survey found that three-quarters of bereaved people rate the overall quality of end of life care for their relative as good or better. But we know that there are variations in the care and services that people receive and we want to continue improving people’s experience of care, including relieving symptoms such as pain," an NHS England spokesman told the Guardian.

The full report is available to download from the BMA website.

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