Doctors should be trained in care of the dying
In a survey of 2,000 physicians carried out by the RCP, just one-third of them had participated in end of life training in the last five years.
The RCP has recommended that all hospital doctors undergo end of life care refresher training every five years. Currently, only palliative care doctors undertake further end of life care training after qualifying, and they are only required to do this once in their careers.
The report says that all physicians should understand the need to discuss "promptly" options for end of life care in order to give patients and carers as much time as possible to make choices. Decisions would then be more likely to be shared with health professionals.
The report found that patients are frequently only treated for their current crisis. By the time they are identified as being in the last stages of life, it is often too late for care arrangements in a hospice or at home to be made. This means that more people than necessary are dying in hospital.
Professor Mayur Lakhani, a practising GP and Chair of the Dying Matters Coalition and the National Council for Palliative Care, commented: “The Royal College of Physicians is absolutely right that hospital doctors have a key role to play in identifying patients entering the last phase of their lives so they can discuss dying with them and ensure the best possible care. This is vital as most people still die in hospital despite a preference to die at home, and 92,000 people have an unmet need for palliative care. Moreover, many doctors, like the general public, find it difficult to talk about dying and death.
"Building on the Find your 1% campaign aimed at GPs, I would urge hospitals to formally adopt guidelines for prognosis and routinely use the 'surprise question' which I find very useful as a practising GP: 'Would I be surprised if this patient died in the next year?'."
Dr Fiona Hicks, consultant in palliative medicine and chair of the RCP's working party on improving end of life care, said: "While doctors always aim to do their best for their patients, for a variety of reasons some physicians are not delivering the best care in the last phase of life. A quarter of a million people die in hospitals in England every year. All physicians must be supported to improve their skills in caring for patients facing the end of life.
"The concept of end of life care in the public's and the professionals' mind is that in the last hours or days or life. We need to be recognising this much earlier."
Dr Linda Patterson, clinical vice president of the Royal College of Physicians, said: "Patients are often at their most vulnerable when facing the end of their lives. At this time, patients need care and compassion.
"Physicians must be able to facilitate shared decisions with patients when possible, and wherever possible ensure that patient’s preferences are met."
The RCP report has come out in the same week that the goverment has announced a £1.8million pilot project aimed at addressing funding inequality in palliative care.
The Dying Matters Coalition has carried out substantial work in improving the end of life care skills of GPs. This includes a GP communications project which showed that with limited intervention it is possible to transform the confidence of GPs in talking about dying with patients and, as a consequence, measurably improve end of life care. Find out more about the GP pilot project.
In February this year, we launched a DVD aimed at boosting GPs' confidence in end of life conversations. 'How long have I got, Doc?' shows GP-patient conversations based on real-life best practice scenarios, as well as offering advice from a number of practising GPs. Find out more about 'How long have I got, Doc?'
In addition, we have set up the Find Your 1% campaign together with the Quality, Innovation, Productivity and Prevention End of Life Care workstream (QIPP). On average, one per cent of a GP's patients will die every year, and the campaign aims to help GPs identify who they are. Find out more about the Find Your 1% campaign - please note, the Find Your 1% campaign is intended for clinicians and health workers only. You will need to subscribe to access information.