Education, education, education

Following the release of our Triggers for Palliative Care report and in light of the recent draft NICE guidelines on care of the dying in England, Professor Bill Noble, Medical Director at Marie Curie, talks about the necessity for more training.

OurTriggers” report highlighted the fact that doctors and nurses don’t receive enough training to be able to recognise when someone needs palliative care.  It also showed there is limited understanding of what palliative care can do, who it benefits and when to consider it.  The publication of the draft NICE guidelines, last month, also recognised that more needs to be done to ensure that professionals provide high quality, compassionate care for people who are dying. 

The draft NICE guidelines mark an important step, but we can’t look at this in isolation, or see this as the solution to failings in care. Clinical practice won’t change unless there is greater emphasis on training and professional development for staff that care for dying patients and their families. 

Get them while they’re young

Better training on understanding of what palliative care can do, and recognising the signs of need or triggers for palliative care, would help. Palliative care training starts with undergraduates, as all doctors, at some point, have dying patients under their care. At the moment, undergraduates have varying amounts of training in care of the dying.  A big step forward would be to ensure all undergraduate courses include a compulsory clinical attachment to a specialist palliative care team during their rotations to teach understanding of the role palliative care can play. At an early stage in their careers, trainees must understand the need to focus on the person in front of them and dealing with their distress. 

Continuous professional development (CPD)

 “Triggers” told us that although links between cancer specialists (oncologists) and palliative care teams are well-established, many other specialists lack an understanding of how palliative care can benefit their patients. Palliative care should feature as a CPD requirement for all relevant specialties, particularly A&E and care of the elderly. 

The surprise question

Doctors often use the “surprise question” when assessing whether someone needs palliative care:

"Would I be surprised if this person dies in the next year?"

If we consider the findings of our report, which are echoed by the draft NICE guidelines, we need to ensure greater emphasis on the specific needs of the individual and their family. The surprise question is too concerned with prognosis, something us doctors are not very good at.  

It also means that many people living with long-term conditions or a terminal illness miss out on the benefits of spiritual, psychological, medical and social care support that palliative teams offer. 

Instead, perhaps what we should be asking is: 

"Could palliative care help imrpove my patient's quality of life?

With more people dying each year, demand for high-quality care will only increase.  Without comprehensive palliative care training and development, failings in care that were identified in the recent Health Service Ombudsman report will continue.