by Dr Nikki Pease, Consultant in Palliative Medicine, Velindre NHS Trust, Cardiff, Wales (Cymru)
December 2016 saw the launch of the Serious Illness Conversation Cymru project. It is an all Wales project supported with funding from Welsh Government’s End of Life Care Board. The project, which held its pilot teaching event in December 2016 (picture 1) strives to deliver a ‘toolkit’ for communication; supported by a breaking bad news strategy that is immediately clinically applicable to front line staff in various healthcare settings. The communication skills toolkit used has been written by the clinical lead for the project (Dr Nikki Pease) and has been taught both nationally and internationally for over 10 years by Cardiff University. (1)
Healthcare staff initially targeted were ambulance clinicians, e.g. paramedics and non-emergency patient transport staff (NEPTS), Specialist Nurses in Organ Donation (SNODs) and clinical leads in organ donation (recognising Welsh Governments commitment to continued improvement in organ donation within the principality), prison staff (recognising the frequent difficulties in managing end of life care within prisons throughout Wales) and specialist nurses involved in cancer care. Although teaching sessions were specifically targeted towards there professionals other professions that asked to attend were accepted and included.
Between 12th Dec 2016 and 28th Nov 2017 (date this article was written) there have been:
• 19 teaching sessions with 423 NHS/HMP staff in receipt of serious illness conversation training. (Table 1)
• A further 5 teaching sessions were delivered at conferences which saw a further 351 attendees receive Serious Illness Conversation Cymru teaching (Table 2).
These sessions were often shorter (40-60 mins) and whilst they will have delivered some communication skills to staff, the author recognise that a comprehensive understanding of how to use the communication toolkit in promoting serious illness conversations (SIC) is unlikely to have been fully met.
Table 1 Professionals attending full training:
| Profession (All Wales) | Attendees |
| Paramedics | 254 |
| SNODs/CLODS/ITU | 83 |
| Prison staff | 41 |
| Nurses | 45 |
| Total | 423 |
Table 2 Professionals who attended shorter training:
| Profession (All Wales) conferences | Attendees |
| Therapist (OT/Physio) | 40 |
| Lung cancer conference | 98 |
| Breast cancer nurses | 92 |
| Various Healthcare staff | 98 |
| Cancer Clinical nurse specialists | 23 |
There are a further three teaching sessions planned (Wrexham for paramedics and Swansea and Cardiff prisons). Formal feedback looking at individuals role and self-scoring pre and post SIC teaching have been collected, the outcome of this will be reported at a later date. Anecdotal feedback has been positive with one paramedic e-mailing in after a shift:
‘Hi – just home from a clinical shift today in which I attended an EOLC patient.. the first one I’ve been to armed with the communication training. I cannot tell you how helpful it was. The patient’s wife hadn’t realised how poorly he was, so I had that ‘difficult conversation’. It really did go similar to the role play in the CPD event’
Although the project has achieved considerable coverage in less than a year, there have been challenges. To illustrate, there are in excess of 2000 paramedics in Wales and each one would benefit from training. However manpower issues prohibit large numbers of Paramedics and NEPTs attending teaching sessions.
The clinical team addressed this by:
1) Seeking to teach paramedic students in training (pic 2) i.e. before they qualify as paramedics
2) Developing a bespoke e-learning programme (pic 3) which offers 4 hours of training to Welsh Ambulance staff.
These elearning programmes are interactive with video clips to demonstrate various aspects of Serious Illness Conversations Cymru. There is on-going work to ensure that the series of 5 modules will become mandatory for ambulance staff throughout Wales and will be supplemented with an hour of face to face teaching.
The clinical teams recognise that this is a short project, the funding of which is finite. The SICCymru team have been working closely with palliative care teams all over Wales to ensure local team ownership (pic 4) e.g. within North Wales the Palliative Care team have recently supported teaching within Berwyn Prison, Wrexham and will continue to liaise and build on developing first class end of life care within the prison setting.
The project has been accepted as a Bevan Commission Exemplar Project and results of our first data collection regarding emergency service transfer to hospital of palliative care patients have been promising. Where an ambulance is called, preliminary results indicate a decrease in patient transfer to hospital and an increase in ‘shared decision making’ where the attending paramedics have liaised with the patient, their family, primary care and/or palliative care clinicians to help guide most appropriate care.
1 Pease, N., 2017 Communication to promote life near the end of life. In Kissane D, Blutz B et al ed. Oxford Textbook of Communication in Oncology and Palliative Care 2nd Editon. Oxford University press 2017 Chapter 49
2 Simon Noble, Nicola Pease, Ilora Finlay 2010 ‘The United Kingdom General Practitioner and Palliative Care Model’ Chapter 57 in Handbook of communication in oncology and palliative care. Oxford University press