34 Recognising the patient with frailty or dementia approaching the end of life – focus group reports

Objective In an attempt to address the findings of the CQC report ‘A different ending – addressing inequalities in end of life care’ we explored staff perceptions of end of life care in the Care of the Elderly (COTE) wards of an acute hospital trust. Method We conducted focus groups with health care professionals (HCPs) (nurses, junior doctors and allied health professionals) working on two COTE wards in November 2016. We used vignettes describing a frail elderly person and a person with dementia to aid discussion. During the focus groups, the facilitators wrote copious notes which were then analysed to produce a summary of participants’ views, supported by verbatim quotes. Results We spoke to 31 HCPs. Key themes identified were: patients try to discuss their imminent death but are prevented from doing so by staff and families; whilst HCPs recognise reduced oral intake as a symptom of approaching death, this is not well explained to families, leading to conflict and distress; care is directed by senior medics and other staff do not always feel able to challenge interventions they deem inappropriate. Conclusions HCPs can recognise patients with frailty or dementia approaching the end of their lives, but feel unable to discuss this with the patients or their families. Early discussions around goals of care may reduce their feeling that ‘patients are done to’. They would welcome learning about better communication skills with these patients and considered this as important as learning life support skills. No funding was obtained for this study.