End-of-life care – Primary Care Research & Teaching Blog

Creating a community network to tackle inequities in end-of-life care and bereavement support

Posted on January 26, 2023January 27, 2023 by capcbristol

By Lucy Selman, Associate Professor of Palliative and End of Life Care, Palliative and End of Life Care Research Group and Centre for Academic Primary Care, University of Bristol

Serious illness and bereavement affect us all, but our experiences of them are not equal. People living in the poorest areas of the UK are less likely to get the care and support they need if they become seriously ill or a loved one dies. They are also more likely to be socially isolated and lonely – which can be made even worse by serious illness or bereavement.

The Weston-super-Mare community network for health inequities is a new collaborative research project, funded by the Arts and Humanities Research Council and led by the University of Bristol, which aims to tackle these issues, focusing on Weston-super-Mare, a seaside town in the South West that is socioeconomically … Read more

How do we provide high quality palliative care in the community?

Posted on October 5, 2022October 5, 2022 by capcbristol

By Dr Tanuka Palit, NIHR Academic Clinical Fellow in Primary Care, Centre for Academic Primary Care, University of Bristol

“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” Dame Cicely Saunders

Many people express a wish to die at home. The proportion of deaths that occurred in the community (including private homes and care homes) rose significantly during the pandemic and has been sustained. As a consequence, the need to fund and improve our community palliative care services has never been more important. Earlier this year, this was recognised by a change in the Health and Social Care Bill to fund palliative care services in all areas. This will hopefully remove the postcode lottery that currently exists in the UK for … Read more

How UK newspapers made sense of COVID-19 related death and bereavement

Posted on March 31, 2021 by capcbristol

by Dr Ryann Sowden, Research Assistant, Population Health Sciences, Bristol Medical School and Dr Lucy Selman Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

In a paper published recently in PLOS One, we explore the coverage of COVID-19 in British newspapers with a focus on key media narratives about the virus.

COVID-19 and media narratives

COVID-19 has caused over 120,000 deaths in the UK, leaving over a million people bereaved. Although death is often described as a societal taboo in British culture, it remains ever-present in the public realm of news and media which COVID-19 has dominated for the past 12 months.

In the spring of 2020, as the COVID-19 pandemic began to claim a large number of lives in the UK, newspapers reported on the threat, damage and bereavement caused by the virus, as well as providing a … Read more

Funerals in the COVID-19 pandemic – how restrictions might affect the bereaved

Posted on July 23, 2020July 23, 2020 by capcbristol

by Dr Alex Burrell, Foundation Year 2 doctor, North Bristol NHS Trust and Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

Restrictions on funeral attendance have been put in place to try to prevent the spread of COVID-19. We conducted a rapid systematic review to try to understand what impact these restrictions might have on the bereaved. We found that the impact of funeral practices was not clear-cut: observational studies assessed different outcomes and their results varied. However, there were important lessons from qualitative research. What seems to be most important is helping people create a meaningful personal ritual which provides a sense of social support however they mourn, whether together in person or virtually.

COVID-19 has caused hundreds of thousands of deaths around the world, with over 45,000 confirmed deaths in the UK as of 23 July … Read more

Care homes have long been neglected – the pandemic has shown us how bad things are

Posted on July 13, 2020 by capcbristol

by Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol

Before COVID-19, there were around 10,000 deaths in care homes in England and Wales every month. Then, between March 27 and April 24 2020, the number more than doubled to 23,113.

The Office for National Statistics (ONS) later reported 17,422 deaths of care home residents from COVID-19 between the end of March and June 5, accounting for 47% of the total number of deaths caused by the virus.

So it is unsurprising that the pandemic has led to much greater interest in what happens inside care homes. As well as the significant increase in the number of residents dying, concerns have been raised about a lack of access to testing and personal protective equipment (PPE), the discharge of coronavirus-positive patients from hospital to care homes, rationalisation of the health … Read more

How coronavirus has transformed the grieving process

Posted on April 20, 2020April 20, 2020 by capcbristol

Dr Lucy Selman, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol

As I write this, the UK government has just announced that 13,729 people have died in hospitals from COVID-19. Care England estimates more than 1,400 people have now died in care homes. As you read this, those appalling figures will have grown. The national medical director, Stephen Powis, has said that if the UK death tally comes in below 20,000, “we will have done very well”.

As a result, a wave of grief will swell in the coming months, with more and more people experiencing a close bereavement related to COVID-19. The disease brings new challenges in caring for patients and supporting their family and friends. A particularly cruel one is that patients must be isolated to control the spread of infection.

Since a patient’s loved ones are often unable to accompany … Read more

Why GPs and patients need to talk more openly about death

Posted on May 17, 2019 by capcbristol

By Dr Lucy Pocock, GP Career Progression Fellow, Centre for Academic Primary Care, University of Bristol

Dealing with death is part of the job description for all doctors. For those working in general practice, this often means planning ahead, with GPs encouraged to keep a register of patients thought to be in the last year of their life.

One reason for this is to identify which patients might benefit from palliative and supportive care – the kind of care which focuses on symptom control, rather than cure. At the moment, these registers appear to consist mainly of patients with cancer. Yet most people (72%) in England don’t actually die of cancer. So why aren’t other dying patients being registered?

To answer this question, it is helpful to think about how we die. As a GP, I can often predict, to some degree, a decline … Read more

Why doctors need to improve the way we discuss assisted dying

Posted on November 23, 2017July 26, 2018 by capcbristol

Dr Paul Teed
PhD candidate
Centre for Academic Primary Care
University of Bristol
@DrPaulTeed

Assisted dying can be a divisive and polarising subject. But there is one aspect on which most people probably agree – the need to improve the conversations people have about death.

At the moment, there is uncertainty in the UK regarding what people – especially health professionals – can and cannot say when the topic of assisted dying comes up. Conversation can become especially stilted when it turns to patients obtaining the medical documentation required for an assisted death abroad.

The situation requires clarification. Currently, if a doctor in the UK writes a specific report to help with an assisted death abroad (three organisations in Switzerland accept UK citizens), the General Medical Council (GMC) may view this as a “fitness to practice” issue.

However, if a doctor provides copies of medical records, even with the … Read more