Communication practices and decision-making

The complexity of personal, emotional and physical situations towards the end of life means that discussions and decision making are a very sensitive but a very important area of care.

RESEARCH AT LOROS

Our communication practices

Video-based research and training in decision-making in end of life care

LOROS collaborates with Professor Ruth Parry to develop an evidence base about communication practices in discussions with patients and family members with serious illness. Real Talk, a training resource for health professionals, is a key output from this work.

There are a number of very useful blogs and ‘in a nutshell’ summaries available on the Real Talk website.

Key Publications

Land V, Parry R, Pino M, Jenkins L, Feathers L,Faull C. Addressing possible problems with patients’ expectations, plans and decisions for the future: one strategy used by experienced clinicians in advance care planning conversations. Patient Education and Counselling 2019; 102; 670-679

Pino, M. Parry, R. Feathers, L. and Faull, C. (2017) ‘Is it acceptable to video-record palliative care consultations for research and training purposes?' A qualitative interview study exploring the views of hospice patients, carers and clinical staff’, Palliative Medicine, pp. 1-9. DOI: 10.1177/0269216317696419

Pino, M. Parry, R. Land, V. Faull, C. Feathers, L. Seymour, J. (2016). Engaging terminally ill patients in end of life talk: How experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE 11(5): http://dx.doi.org/10.1371/journal.pone.0156174

Continuing Bonds: Exploring the meaning and legacy of death through past and contemporary practice

This project looks at how archaeology can inform our current attitudes to death and dying and whether the diverse methods of dealing with death and the dead uncovered by archaeologists can bring a different perspective and contribute towards a necessary re-examination of today's taboo status of death as an inevitable human experience.

Visit the Continuing Bonds project website for more information and for access to Blogs from the research team.

Key Publications

Croucher K, Green L, Buster L, Dayes J, Faull C. Archaeology and contemporary death: Using the past to provoke, challenge and engage.  PLoS ONE 15(12): e0244058 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244058

Dayes J, Croucher K, Buster L, Faull C, A Poem Evidencing the Value and Relevance of Archaeology to Professionals Working in End-of-Life Care. BMJ SPC Rejected as article. http://dx.doi.org/10.1136/bmjspcare-2017-001452.

Büster L,  Croucher K, Dayes J, Green L, Faull C. From Plastered Skulls to Palliative Care: What the Past Can Teach Us About Dealing with Death.  Public Archaeaology 2018: Special volume Death in the Contemporary World: Perspectives from Public Archaeology 3: 249-276

Exploring the experiences of families and health professionals supporting a patient with Motor Neurone Disease (MND)

In our work we are exploring, from the perspective of the patient, their health professionals and close family the issues related to using ventilation and to its withdrawal of at the request of a patient with MND.

Key publications

Phelps, K., Regen, E., Oliver, D., McDermott, C. and Faull, C. (2015). Withdrawal of ventilation at the patient's request in MND: a retrospective exploration of the ethical and legal issues that have arisen for doctors in the UK. BMJ Supportive & Palliative Care, pp.bmjspcare-2014-000826.

Withdrawal of Assisted Ventilation at the Request of a Patient with Motor Neurone Disease: Guidance for Professionals. Version 1.0 November 2015. Association for Palliative Medicine of Great Britain and Ireland: http://apmonline.org/publications/

Anticipatory prescribing for symptom management at the end of life

Distressing symptoms are quite common in the last days of life and their management needs prompt administration of medications delivered by injection.

We have undertaken two studies to identify and explore the issues that arise in relation to the prescribing and use of subcutaneous ‘Just-in-Case’ medicines (midazolam and diamorphine) for dying patients.

Our first study with health care professionals is complete and was cited as evidence in the NICE Guideline NG31 2015.

Our second study with bereaved family members is in press.  You can see a poster of some of the findings here.

Publications

Faull C, Windridge K, Ockleford E, Hudson M 2013. Anticipatory prescribing in terminal care at home: what challenges do community health professionals encounter? BMJ Supportive and Palliative Care 3:91-97.

Completed projects

Decision making with frail patients who have a surgical problem.

Factors that influence decisions about cardiopulmonary resuscitation: the views of doctors and medical students.  

LOROS, Groby Road, Leicester LE3 9QE