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Focus on working with GPs Eve Richardson. THE DYING MATTERS COALITION. Set up by the National Council for Palliative Care, the umbrella Charity for all those involved in palliative care, to support the 2008 End of Life Care Strategy

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Focus on working with gps eve richardson

Focus on working with GPsEve Richardson

The dying matters coalition

  • Set up by the National Council for Palliative Care, the umbrella Charity for all those involved in palliative care, to support the 2008 End of Life Care Strategy

  • It is a broad based, inclusive national Coalition, working in partnership, with over 17,000 members from across the NHS and voluntary and independent health and care sectors, social care and housing, faith, community, retirement organisations, schools, legal, insurance, funeral and finance sectors

The challenge

“Many consider death to be the last great taboo in our society and ….most of us find it hard to engage in advance with the way in which we would like to be cared for at the end of life.”

End of Life Care Strategy, Department of Health, 2008

Why we don t talk about dying
Why we don’t talk about dying

Death is a long way off

47% of men

43% of women

20% of 75+

3% of 75+

I am too young to think about it

16% of women

19% of men

Implications for actions
Implications for Actions


is the key needed to make it easier for more people to talk about it

Different Approaches/tools

Needed for different groups/audiences

target groups:

55 – 65s

65 – 75s


The “It’s a long way off” perception:

People more likely to talk to trusted family members and GPs

2010 2011 dying matters gp communications skills pilots
2010 & 2011 Dying Matters GP Communications Skills Pilots

Aims of gp pilot
Aims of GP Pilot

  • Aims to support GPs in their initial discussions about a patient’s wishes when the subjects of death, dying and bereavement arise

  • Focus on the role of GPs as key influencers in end of life care, in initiating discussions and helping people to plan about their choices

Changes in gps confidence
Changes in GPs confidence

Changes in confidence in having conversations of all GPs participating

in the Dying Matters GP Pilots 2010 & 2011

Continuing the conversation
Continuing the conversation

  • How patients responded:

  • 178 chose to continue the conversation

  • 21 rejected the conversation

  • 9/10

  • Nine times out of ten, patients will continue the conversation about end of life

“My experience has been that the majority of the patients with whom I have had these conversations have been relieved and appreciative. Only very occasionally (perhaps 1 in 10 times) did patient not wish to discuss the prospect of deteriorating health and increasing care needs and implications of this”

Gp actions following a conversation
GP actions following a conversation

Actions taken recorded by GPs following 208 conversations about end of life with patients and their families and carers

Organisational and professional barriers
Organisational and Professional Barriers

  • Time both in practice and in the home

  • Timing if the patient is unwell timing important

  • The range of professionals involved in end of life care & need for good co-ordinated care which may not be available

  • Staff Attitudes many avoid discussions as do not want either patient’s or family / carers to give up hope

Dealing with denial
Dealing With Denial

“ interestingly the barriers often came from the relatives who were in denial ”

“Many doctors still feel that ‘denial’ is the...most frequently chosen method of coping with EOL”

“Some patients simply do not wish to address all these issues; some do; some do only with careful prompting”

Awareness week survey findings 2012 progress
Awareness Week Survey Findings 2012- Progress

  • 35% of GPs have not initiated a discussion with a patient about their end of life wishes

  • Only 33% of GPs have asked a family member about their end of life wishes

  • 35% have talked to someone about their own wishes

  • 56% of GPs have written a will, (52%- up from 42%) have registered to become an organ donor

  • 7% have written down their end of life wishes (up from 5%)

    Comres 2012

Find your 1 campaign supporting gps in delivering quality end of life care
FIND YOUR 1% CAMPAIGNSupporting GPs in delivering quality End of Life Care

Campaign content now unrestricted

  • We listened to what GPs and other

  • health professionals told us and simplified

  • access to the content.  

  • From now on, all of the clinically-rich

  • resource materials on the site are

  • accessible without restriction.

  • To receive regular updates on the

  • latest news, information, case studies and

  • resources around end of life care, GPs and

  • other health professionals are encouraged to sign up to our e-news updates.



Social network promotion

Increased gps confidence in starting conversations about end of life
Increased GPs confidence in starting conversations about end of life

  • Pilots showed a change in their self-reported confidence in both initiating and having conversations about end of life between the pre and post pilot phase

  • This is contributing to good deaths

  • The training is now being rolled out and will also support the GP 1 % campaign to help 5000 GPs get their patients wishes met by March 2013

  • 2 events planned in North West

More help is at hand of life

Low-cost inventions can make a significant difference

  • Example: Dying Matters GP pilot project

  • Before intervention 45% GPs rated themselves as unconfident in end of life conversations, at end 94% either “confident” or “very confident”