Utilising feedback from patients and their families as a learning strategy in a Foundation Degree in palliative and supportive care: a qualitative study.

BACKGROUND: In the UK, support workers provide much of the care that palliative care patients receive, and a novel Foundation Degree was developed to enhance their skills. Feedback on performance is a recognised educational tool that reinforces good practice, and gives insight into areas of weakness, but its use with this workforce has not been described. AIM: The aim of this qualitative study is to explore tutor and support workers' experiences of seeking and receiving feedback from patients and their families; focusing on its values and challenges. METHODS: Support workers enrolled onto the Foundation Degree in Palliative and Supportive Care, were asked to seek feedback from patients and/or their families about the care that they provided using a 'My Experience' questionnaire. Forms were returned anonymously to the course tutor who discussed results with the student as a formative education strategy. The students' experience of this was explored in focus group interviews at three time points. Two tutors' experiences were similarly explored. Results were analysed thematically. RESULTS: Students enjoyed receiving feedback. Positive feedback helped to increase confidence, and negative feedback allowed students to look critically at their practice and identify areas of weakness. Some experienced challenges in approaching patients/families due to having a small number of suitable patients/families; a reluctance to burden patients; high patient turnover and brevity of care relationships. The tutors enjoyed delivering feedback, recognising its benefits as an educational strategy. Some concern was expressed about how to balance delivering negative feedback while continuing to provide tutorial support throughout the Foundation Degree. CONCLUSIONS: User feedback is considered a key formative educational strategy. Its use in health and social support workers is not established. The experiences of students and tutors in this Foundation Degree demonstrate some of the benefits and challenges of this as an educational strategy.

Influences on the decision to prescribe or administer anticholinergic drugs to treat death rattle: a focus group study.

BACKGROUND: The evidence supporting pharmacological treatment of death rattle is poor; yet, anticholinergic drugs feature in end-of-life care pathways and guidelines worldwide as a treatment option. AIM: This qualitative arm of a wider study aimed to explore important issues which health-care professionals associated with decision-making to prescribe or administer anticholinergics at the end of life. DESIGN: After purposive sampling, five focus groups were conducted. Discussions were audiotaped and transcribed verbatim. SETTING: Thirty medical and nursing personnel working in inpatient and community settings from two specialist palliative care units in the United Kingdom took part in the study. RESULTS: Thematic analysis of transcripts from audiotapes revealed perceived pressures to prescribe and/or administer anticholinergics from colleagues and carers, and drugs were often prescribed or administered in order to be seen to 'do something', although the benefit in terms of therapeutic response was considered minimal. Familiarity with drug regimens and dosing was often based on personal experience. The monitoring of side effects of anticholinergics at the end of life was recognised as problematic and had little influence on prescribing and administration. There was also an indication that patients and carers in the community were more likely to receive timely verbal preparation and explanation around death rattle than those cared for in an inpatient setting. CONCLUSION: The study raises questions about the routine inclusion of anticholinergic treatment in UK end of life care pathways for the treatment of death rattle.