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14.03.16

Doctors need better training on treating dying patients – BMA

Dying patients are being failed by the health service and doctors need better education to support them, the British Medical Association (BMA) has said in a new report.

The report, the third and final part of a series, found that care for the dying was inconsistent across the country, with problems such as miscommunication and delays in providing pain medication frequently occurring.

It also said that a significant proportion of doctors at all stages of their careers said they lacked confidence discussing the end of life with patients, assessing patients’ mental capacity and administrating pain relief.

It recommends that doctors be given more time to speak with patients and their families, ongoing support in accessing training for treating dying patients, and emotional support while caring for them.

Dr Ian Wilson, chair of the BMA’s representative body, said in the report’s foreword: “There is a clear desire amongst doctors to have better support and training to help improve the care they can offer patients at the end of their lives, whilst both doctors and the public recognise the pressures on doctors’ time, and that the communication and coordination on which the best examples of practice so depend are too often constrained by conflicting demands on that time.”

The report recommends improvements a variety of areas including recognising when patients may be dying, adequately addressing mental capacity issues for decision-making and treating comorbid mental disorders, avoiding inappropriate and unnecessary hospital admissions, improving inefficient and slow discharge processes to transfer people out of hospital once they have been admitted, and introducing an approach to the care of people dying from conditions other than cancer.

The report also says that more should be done to provide patients with a choice between dying at home or in the hospital, although it said more investment in palliative care infrastructure is needed to make this happen.

The BMA, which opposes the legalisation of assisted dying, also asked doctors about their attitudes to physician-assisted suicide.

They found a lack of awareness about physician-assisted suicide amongst doctors, with many unaware of all the countries where physician-assisted dying is legal, the methods used or the risk of failure sometimes found with the procedure, and doctors admitting they hadn’t considered aspects of the issue such as the impact legalisation would have on the patient-doctor relationship.

However, the doctors interviewed felt that there is increasing political momentum behind improving end-of-life care.

The 11th Palliative Care Congress was held in Glasgow last week from 9-11 March, and Dying Matters, a coalition aiming to change public attitudes to death and dying, will hold an awareness week from 9-15 May.

Last October, the Economist Intelligence Unit ranked the UK as having the best palliative care in the world, but warned that services face many problems, as a recent Ombudsman investigation into complaints about end-of-life care across England found.

NICE published new guidelines on palliative care last December, recommending that it become more individualised and interlinked.

Comments

Richard Collins   14/03/2016 at 14:54

Very interesting report from the BMA. As with other areas of the care system, palliative care will only "work" if there is sufficicient resource devoted to it

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