“Difficult conversation” about death

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Health staff could be asked to complete “ReSPECT” forms, specifying how they want to be treated as death approaches, to help empathise with patients as preparing for the end of their lives, an NHS trust director has suggested.

Jane Povey, Shropshire Community Health NHS Trust’s Medical Director, also said the organisation avoids calling it a “difficult conversation” as this phrase is intimidating even for medical staff. “Important conversation” is more appropriate, she added.

Dr Povey was giving a presentation to the Joint Health Overview and Scrutiny Committee about a review of end-of-life care in Shropshire, Telford and Wrekin.

Standing for “Recommended Summary Plan for Emergency Care and Treatment”, the ReSPECT process aims to establish a patient’s preferences for when they might later be unable to communicate them.

Healthwatch Shropshire Chief Officer Lynn Cawley asked: “Are staff trained to have these difficult conversations, and when should they take place on a patient journey?”

Dr Povey said the training existed, but was “not reaching all the parts yet”.

She said: “In Telford and Wrekin we have a care home support team, and also there are a couple of doctors who have been coming out of SaTH [Shrewsbury and Telford Hospital NHS Trust] and visiting some of the care homes to enable this. So we’ve got examples of where there is extra support.”

Dr Povey said a recent decision by Health Education England to approve funding for more training in the area showed “they recognise we’re on the right track”.

Addressing the question about timing, she said end-of-life planning should not be a “last-minute” consideration. Ms Cawley said a report by Healthwatch found those who had the most difficult cases were those where “right up until the last minute, it seemed, it still had been not acknowledged that patients were at the end of life”. This made “everything a struggle”, she added.

Dr Povey added: “The other thing is, we try to avoid using the term ‘difficult conversation’, because that puts you off even before you start if you’re a fairly junior member of staff. So we call it the ‘important conversations’, because that’s what they are.

“End-of-life care is a generalist function. It should be for everybody that’s involved in health and care.”

Ms Cawley asked: “Couldn’t it be argued that the discussion needs to start when you’re healthy? Because then it’s not stressful.”

Dr Povey said Karen Stringer, a Lead GP for end-of-life care, working at Whitchurch Community Hospital, argued that “we should all be doing ours first, we should all have a ReSPECT form”.

“And why not?” Dr Povey added.

“It’s literally saying how I would want to be treated if things turn difficult. And nothing is going to happen if they don’t.

“So that might be one of the things we do, where every member of staff has someone have the conversation with them and maybe it becomes less difficult.”

The Joint Health Overview and Scrutiny Committee – which consists of Shropshire and Telford and Wrekin councillors, as well as co-opted experts from both local authority areas – will receive an update on the end-of-life review in December.

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