Article Text

Download PDFPDF

Improving quality in hospital end-of-life care: honest communication, compassion and empathy
  1. Deb Rawlings1,
  2. Kim Devery2,
  3. Naomi Poole3
  1. 1Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
  2. 2Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia
  3. 3Director, Partnering with Consumers, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
  1. Correspondence to Deb Rawlings; deborah.rawlings{at}


Background With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: ‘Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…’

Methods The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated.

Findings Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice.

Conclusion Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention—behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.

  • end-of-life
  • practice change
  • intent-to-change practice

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors KD and NP were involved in the original project conception and grant. KD developed the education modules. DR and KD conceptually developed the paper, which was drafted by DR. All authors commented on, reviewed and approved the final draft.

  • Funding EOLE is funded by the Australian Government Department of Health.

  • Disclaimer The funding body and ACSQHC have no role in the development or writing of the article.

  • Competing interests KD and DR have received salary funding from the End of Life Essentials (EOLE) project. NP is employed by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval for the project was granted by the Social and Behavioural Research Ethics Committee at Flinders University, Adelaide, South Australia (Project 7012).

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.