The implementation and evaluation of a psychosocial care programme to improve the patient experience at the end of life
 
Background
Local and national guidelines prioritise psychosocial care and identify minimum standards against which such care should be measured.  However an education needs assessment at the hospice established many staff had a lack of knowledge and understanding of psychosocial care, resulting in low confidence when providing this aspect of care. 

Purpose
The study aimed to develop and evaluate a psychosocial care education programme that is relevant and applicable to all health professionals providing end-of-life care.  Key objectives were to ascertain whether attendance on the programme increased understanding of the key principles of psychosocial care and increased self-reported confidence in providing this aspect of care.

Methodology
The study adopted a between-methods approach i.e. the collection of both qualitative and quantitative data.  Nine staff from the hospice attended the programme run over three days, one day per month.  Data collection included a confidence questionnaire administered before and one month after the total programme; knowledge questionnaires administered before and after each individual study day; an audio-taped interaction with a patient between day two and three; an audio-taped observation with a patient after day three; and a focus group six months after completion of the programme.  Ethics approval was granted by the local research ethics committee.

Key Findings and Conclusions

• All participants reported an increased understanding of the key issues of psychosocial care and its application to their practice.
• Confidence questionnaires showed an increase in scores for all participants although these must be viewed with caution due to the small sample size.
• The audio-taping and observation of a participant/patient interaction was seen as valuable by participants to enable them to critique their own working practice.
• The observations enabled the evaluation of patterns of relationship between self-reported confidence and knowledge of health professionals and their working practice.
• Participants would have liked more formal feedback on the audio-taped observation.
• Participants brought examples from practice to include on each of the three study days although these were not formally recorded.
• Participants reported a change in their practice in response to an increased understanding and confidence including more frequent and open discussions with patients regarding psychosocial issues.
• Three days was felt to be too short to give full attention to the multitude of topic areas to be covered.

Recommendations

• To extend the programme to five days and incorporate time for examples and reflections from practice.
• To include more formal recording and reflection of practical examples by participants on the programme.
• To increase the number of participants on the programme and to offer the programme to external participants.
• To consider evaluating the impact of the training programme on the patient experience of psychosocial care.