Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more


'Many staff do not appreciate they are actually involved in delivering end of life care'

  • 1 Comment

Claire Henry explains how training can help nurses overcome their unease about talking to patients in a constructive way on quality end of life care

As a society we are about as comfortable talking about death and dying as the Victorians allegedly were in the presence of an uncovered piano leg.

This awkwardness is so deeply imbued in our ‘live forever’, botox culture that nurses and their care colleagues can find it difficult to shake it off when faced with a person clearly nearing the end of life. Then they discover that some of these patients and their families actually want to talk about planning for death.

At the recent Nursing Times Primary Care Live conference, a senior palliative care nurse suggested that this inhibition about talking about death and the dying process was well-established in nursing. Community matron for supportive and palliative care Liz Clements suggested that even some nurses with good communication skills felt a reluctance to broach the issue.

Communication skills in end of life care must include the confidence to both raise the issue of planning for future care and death - when appropriate - and respond to patients or families who raise these issues themselves.

True, communications skills training can sometimes be a theoretical exercise. To be effective rather than a tick box exercise, quality training often needs to involve role play and be adapted to the work setting of those being trained.

Elements of training such as these can help provide the confidence to go with the skill – spotting opportunities for such discussions and responding to them is a key communications skill in itself.

However accessing communications skills training in end of life care can be difficult.

An on-going programme seeking to identify both the need for such training and the most effective way of delivering it published its interim report recently.

Co-ordinated by the National End of Life Care Programme and Connected (the NHS provider of advanced communication skills in cancer services), the initial phase, involving the 12 pilots conducting a training needs analysis (TNA), reported that most staff felt they could benefit from additional communications skills training around end of life care.

The report concluded that while most health staff have some involvement in end of life care, few had received more than basic level training in this sensitive and challenging area. Interestingly, several pilots reported that merely conducting the TNA across local health and social care organisations raised awareness of end of life care – which could itself be the first step to making staff more comfortable in discussing death and dying.

What’s more, they also disclosed there was much misunderstanding about the term end of life care. Many staff do not appreciate they are actually involved in delivering it. This might be why it comes as a shock to many when they find patients or families wishing to talk about death and end of life care. If it achieves nothing else, communication skills training in this area would remind nurses that many of the people they encounter have life-limiting conditions or are in or near the last months or year of their life.

This training can be reinforced by individual mentoring and peer support groups.

As Ms Clements pointed out, conversations with the individual and family lay the foundation for quality end of life care by opening up opportunities for advance care planning and discussions around where they would like to die.

That is why nurses and other care professionals have to be provided with communications training in end of life care that gives them both the skills and the confidence to talk about death and dying.

After all, it is rather more important than a piano leg.

About the author

Claire Henry is director of the National End of Life Care Programme

  • 1 Comment

Readers' comments (1)

  • michael stone

    It is very clear, that the NHS is pretty useless when it comes to 'talking about death'.
    Similarly, the NHS appears to have a problem with reading the wording of the Mental Capacity Act.
    And, the NHS also has a major problem, with applying logic to the potentially very complex (in terms of procedures) situation of dying patients who are at home, as opposed to being in hospital.
    The more recent stuff in this area is an improvement, but it still neglects the blindingly obvious: at home, a patient can talk to live-with relatives, before he has talked to anybody else !

    I am very annoyed by the current 'belief and behaviour set' in this area - you are right, nurses seem to not understand it, and this is not helped by some very poor 'guidance' !

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.