title: Healthcare professionals' perspectives on delivering end-of-life care within acute hospital trusts: a qualitative study.
abstract: OBJECTIVE
  The quality of end-of-life (EOL) care in acute hospitals is variable and interventions to improve this care, such as EOL care pathways, are not always used. The underlying reasons for this variability are not fully understood. We explored healthcare professionals' views on delivering EOL care within an acute hospital trust in the South West of England.
  
  
  METHODS
  We employed qualitative methods (focus groups, in-depth interviews and questerviews) within a study investigating the impact of a simple EOL tool on the care of dying patients. We invited a range of staff of all grades with experience in caring for dying patients from medicine, surgery and care of the elderly teams to participate.
  
  
  RESULTS
  Six focus groups, seven interviews and five questerviews were conducted. Two main themes emerged: (a) delays (difficulties and avoidance) in diagnosing dying and (b) the EOL tool supporting staff in caring for the dying. Staff acknowledged that the diagnosis of dying was often made late; this was partly due to prognostic uncertainty but compounded by a culture that did not acknowledge death as a possible outcome until death was imminent. Both the medical and nursing staff found the EOL tool useful as a means of communicating ceilings of care, ensuring appropriate prescribing for EOL symptoms, and giving nurses permission to approach the bedside of a dying patient.
  
  
  CONCLUSIONS
  The culture of avoiding death and dying in acute hospitals remains a significant barrier to providing EOL care, even when EOL tools are available and accepted by staff.
authors.affiliation: Department of Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK.
authors.forename: Colette
authors.initials: C
authors.lastname: Reid
authors.affiliation: Cornwall Hospice Care, St Julia's Hospice, Hayle, Cornwall, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Gibbins
authors.affiliation: Department of Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK.
authors.forename: Sophia
authors.initials: S
authors.lastname: Bloor
authors.affiliation: Department of Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Burcombe
authors.affiliation: Department of Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: McCoubrie
authors.affiliation: Department of Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D019091:Critical Pathways; D004739:England; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010564:Personnel, Hospital / Q000523:psychology*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods / Q000523:psychology*
keywords: Terminal care; death and dying; end-of-life; healthcare professional; hospital