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Lack of training in respiratory care reduces end of life choice

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Nurses specialising in respiratory care appear less likely than other specialists to receive the training and skills needed to broach end of life discussions with their patients, latest NHS research has suggested.

A report from the National End of Life Care Intelligence Network, published this week, says 69% of patients with respiratory conditions other than lung cancer die in hospital, compared with an average of 58% for all deaths. They are also the group least likely to die at home.

Reducing the percentage of deaths in hospital was a key aim of the National End of Life Care Strategy published in 2008.

The research, which looked at national data for 2007-09, found 14% of deaths were from respiratory conditions - 20% when lung cancer was included.

The report highlighted specific issues around chronic obstructive pulmonary disease. It showed around 16,000 COPD deaths per year occurred in hospital compared with 4,500 at home, around 1,000 each at nursing or care homes, and fewer still in hospices.

The report noted that, while the “disease trajectory” of COPD was unpredictable - being a slow decline punctuated by acute exacerbations - it was important to enable patients to “express and record” their end of life care wishes.

“There is evidence to suggest that more patients with COPD wish to discuss end of life care and prognosis with a healthcare professional than currently occurs,” the report stated.

Report author Julia Verne, director of the South West Public Health Observatory, said: “Raising awareness and good communication would reduce anxiety and could mean more people choose to die at home, confident the services and equipment they need will be in place.”

Dr Verne added there was a need to increase training in the management of COPD exacerbations in community settings.

She said: “The distress and anxiety arising from these episodes probably contributes to the high proportion of deaths that take place in hospitals. Staff should have the training and confidence to provide care that meets these needs in the community.”

Meanwhile, a pioneering palliative care network has been set up in the East of England to improve the skills of care home staff. The Hospice Care Homes Network, led by the St Elizabeth Hospice in Suffolk, organises study days on areas such as communication and spiritual care for nearly 30 homes.

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Readers' comments (1)

  • All of these issues can be largely addressed by appropriate training. It is the decision makers and coffer counters that are accountable for denying or obstructing appropriate training. It seems unethical and morally bankrupt to deem it unnecessary. Good work done by these various network organisations now.

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