End-of-life care: ensuring everyone is prepared (Professor Nancy Preston)
NIHR Greater Manchester Health and Care Research Awards 2022. Second from left Professor Nancy Preston, and to her right colleagues from NWAS and East Lancs - Award for Collaborative Working Accomplishment.
Innovative collaboration upskilling healthcare professionals
Respecting people’s wishes for end-of-life care can mean a better outcome for the individual and the healthcare services involved. But achieving this requires conversations which may be difficult for patients, families and professionals alike. A collaborative project instigated by Lancaster University has built on recent research to make a real difference in this area.
Nancy Preston is Professor of Supportive & Palliative Care and Co-Director in the International Observatory on End-of-Life Care. “During Covid, we had a study running in care homes,” she explains. “It was about working with residents and their families on advance decision making. Off the back of that, we got ESRC funding to develop online training for care home staff. That changed care straight away: staff and families who were previously very nervous about these discussions now felt able.”
Seeing the potential to adapt this resource for all healthcare workers, Nancy brought in two key project partners to co-develop a solution based on supporting Advance Care Planning discussions. “East Lancashire Hospitals NHS Trust (ELHT) wanted to reduce the number of people dying in hospital instead of where they would prefer. At the same time, North West Ambulance Service (NWAS) asked to get involved: there was a huge impact to be had on their response to end-of-life care calls.”
With match funding from an ESRC Impact Acceleration Account (IAA) and the Lancashire & South Cumbria Integrated Care System, the project team held a series of workshops to examine the experiences and needs of a range of stakeholders. Andy Wells, Communications Skills Lead at ELHT, says: “We wanted the complete spectrum, so we had consultants, doctors, nurses, allied health professions… initially from the acute Trust and then from primary care.”
The team also examined the issues from the ambulance service’s perspective. “We invited ambulance technicians and paramedics at varying levels of expertise, from specialists to front-line paramedics,” says Kieran Potts, Regional Lead for Palliative and End of Life Care at NWAS. “We put these groups together with GPs, nurses and other staff. It gelled really well.”
“When ambulance crews turn out on calls and there is no Advance Care Plan in place, they can find themselves having these conversations with someone they’ve never met before, in the midst of quite a traumatic visit.” Nancy says. “So it was great to have them involved, to focus everyone’s minds on how difficult and yet how crucial this communication can be.”
Having helped to fund the workshops and a researcher who assisted with them, the IAA now enabled the team to bring in a professional production company for the online resource, with the project partners creating content for seven staff training modules. The process for administering the grant was very straightforward, Nancy says. “It wasn’t bureaucratic. They were keen on seeing what the impact would be, which was where my focus was. It was well supported and they were very responsive when we needed money. It’s been a real joy, being able to get research outside the University, to make it accessible and get it into practice.”
The resource www.acpsupport.co.uk had its national launch in June 2022. “It’s really taking off and being recognised as a useful tool,” says Andy. “It’s accessible through our learning hub. It’s got pride of place on our home page. And the Trust is taking it seriously. Our end-of-life steering group is now chaired by our Chief Nurse. To have somebody at that level supporting Advance Care Planning is absolutely massive.”
“This has also been a great conduit for a relationship with the University,” adds Kieran. “For us as an ambulance service, it has opened up opportunities for other projects and internships. And what was really positive from a personal and professional development perspective was how this project completely satisfied the research pillar in the model of advanced practice that we all follow.”
Besides upskilling NHS staff to be better equipped to have these conversations and to identify their own training needs, Nancy highlights other impacts, including winning an award for Collaborative Working at the NIHR Greater Manchester Health and Care Research Awards 2022. “The potential for collaboration was an unexpected impact. We’ve secured further projects and grants and developed the researcher’s skills in working with companies, pulling together research and delivering it online. Because it’s OK doing research, but you have to get the impact out there!”
https://www.lancaster.ac.uk/news/nihr-health-and-care-research-award-for-lancaster