Improving End of Life Care for People with Long Term Mental Health Conditions and Terminal Illness - An Exploratory Study of the Experience and Perceptions of Mental Health and End of Life Care Clinicians

摘要

BackgroundPeople with mental illness experience higher rates of many life-limiting conditions and die on average twenty years earlier than the general population. The researcher observed that people with mental illness appeared to be under-represented in hospice care. A literature review was carried out which revealed limiting research concerning the end of life needs of people with long term mental health conditions. The role of clinical staff was highlighted as a key factor, yet their views were not reflected in the published research. There were very limited studies originating in the UK.AimThe aim of this research was to conduct an exploratory study to develop further understanding of how to improve end of life care for people with long term mental health conditions through exploring the views, experiences, attitudes and insights of clinical staff working in both mental health and end of life services.MethodFour focus groups with clinicians were conducted, using the CUbe method (Magee et al 2015), across a large Mental Health Trust and a hospice. 23 participants from a range of professional backgrounds attended and shared their experiences and perceptions of the barriers to delivering good end of life care to people with mental illnesses. The data was analysed using the Framework Method and themes and explanatory concepts were drawn.FindingsThe findings of the study were clustered into five themes: Structural and Systemic Factors, Patient Factors, Clinician and Service Factors, Partnership Factors and Solutions and Improvement Factors. Explanatory concepts were developed from the themes which can be used to inform innovations and improvements to practice.ConclusionThe barriers to providing good end of life care were described within the literature, which largely originated outside the UK. The findings of the data analysis found many similarities and some new findings. Recommendations were made which include improvements to partnership working, involvement of patients, carers and clinical staff in improving care and the need to develop the confidence, knowledge and skills of clinical staff from both mental health and end of life services.