Quality statement 4: Holistic support – physical and psychological

Quality statement

People approaching the end of life have their physical and specific psychological needs safely, effectively and appropriately met at any time of day or night, including access to medicines and equipment.

Quality measure

Measures from End of life care strategy: quality markers and measures for end of life care (Department of Health 2009).

See also quality measures and national indicators for further information.

Structure:

a) Evidence of local arrangements to provide people approaching the end of life with access to psychological support.

b) Evidence of local use of supportive environments for managing psychological symptoms in people approaching the end of life that provide privacy and dignity.

Process:

a) Proportion of people identified as approaching the end of life who have a treatment plan for symptom management incorporating current and anticipated physical and specific psychological needs.

Numerator – the number of people in the denominator with a treatment plan for current and future symptom management incorporating physical and specific psychological needs.

Denominator – the number of people identified as approaching the end of life.

b) Proportion of people identified as approaching the end of life with unrelieved physical symptoms who are referred for specialist palliative care advice.

Numerator – the number of people in the denominator referred for specialist palliative care advice.

Denominator – the number of people identified as approaching the end of life with unrelieved physical symptoms.

c) Proportion of people identified as approaching the end of life with unrelieved specific psychological symptoms who are referred for specialist psychological advice.

Numerator – the number of people in the denominator referred for specialist psychological advice.

Denominator – the number of people identified as approaching the end of life with unrelieved specific psychological symptoms.

Outcome:

a) People approaching the end of life feel satisfied with their level of physical comfort.

b) People approaching the end of life feel psychologically supported.

c) Carers and families of people approaching the end of life feel satisfied with the management of the person's physical comfort and psychological support, where appropriate.

See the overview for overarching outcomes.

What the quality statement means for each audience

Service providers ensure that services are available and systems are in place to meet the physical and specific psychological needs of people approaching the end of life, including access to medicines and equipment, in a safe, effective and appropriate way at any time of day or night.

Health and social care professionals manage physical and specific psychological symptoms in people approaching the end of life, including provision of medicines and equipment, in a safe, effective and appropriate way at any time of day or night. This may include contacting specialists for advice.

Commissioners ensure they commission generalist and specialist services that are able to meet the physical and specific psychological needs of people approaching the end of life, including access to medicines and equipment, in a safe, effective and appropriate way at any time of day or night.

People approaching the end of life receive treatment and care to manage their physical and psychological needs, which may be at any time of day and night.

Source guidance

Department of Health quality markers and measures for end of life care 8.5, 8.8, 10.3, 10.4 and 10.6.

NICE cancer service guidance key recommendations 9 and 12 and recommendations 5.12 and 8.37.

Data source

Structure:

a) Local data collection. National cancer peer review programme – Manual for cancer services: psychological support measures: various measures relating to psychological support for people with cancer (no national data collection).

b) Local data collection. The NHS inpatient services survey asks inpatients (not specific to end of life care) whether they were given enough privacy when discussing their condition or treatment.

Process:

a) Local data collection.

b) Local data collection. The draft End of life care locality register pilot programme comprehensive dataset from the Information Standards Board records whether the person is known to a specialist palliative care team.

c) Local data collection.

Outcome:

a) Local data collection. Office for National Statistics (ONS) National bereavement survey (VOICES) includes questions on how well the person's pain was relieved. The National care of the dying audit – hospitals may be relevant. The NHS inpatient services survey asks inpatients (not specific to end of life care) whether they were ever in any pain and whether they thought that hospital staff did everything they could to help control their pain.

b) Local data collection.

c) Local data collection. Office for National Statistics (ONS) National bereavement survey (VOICES) includes a question on the level of support provided for relief of pain and other symptoms.

Definitions

It is recognised that physical and psychological symptoms cannot always be fully controlled. Effective symptom management results in the optimum comfort level that can be achieved for the person approaching the end of life, within clinical possibility and limitations, and patient choice. All treatment and support should be tailored to the individual.

The treatment plan for managing symptoms and side effects should be recorded in a personalised care plan described in quality statement 3.

Safe, effective and appropriate symptom and side-effect management at any time of day or night may require coordinated input from a number of different professionals and services. As a minimum, essential 24/7 care services should include:

  • generalist medical services (including GPs)

  • nursing services (defined as visiting, rapid response services and provision of one-to-one care at home, including overnight)

  • personal care services

  • access to pharmacy services

  • access to equipment and adaptations

  • specialist palliative care advice for generalists on symptom and side-effect management.

Psychological support encompasses general emotional support and empowerment as well as specialist psychological care. Emotional support is covered in quality statements 5 and 14. Specific psychological needs are more likely to require psychological interventions beyond the general emotional support that most people will need. Psychological interventions may include, but are not limited to, cognitive behaviour therapy, social skills training, work with phobias and confidence issues, and medication to ease psychological distress, including anxiety and depression.

Timescales for addressing symptoms and side effects will depend on the individual symptom, comfort and preferences of the person approaching the end of life and should be determined by clinical judgment. Response times should be independent of care setting.

Appropriate steps should be taken to alleviate symptoms in all circumstances, including where the person approaching the end of life is unable to communicate.