Between 2016–2018, 375,400 people were diagnosed with cancer and between 2017–2019 167,142 people died from cancer in the United Kingdom . 64% of patients with a cancer diagnosis express a wish to die at home although currently only 30% manage to do so . The Primary Care team who look after a person with cancer remains the same unless they move or change practice. Their household will also, in most circumstances, be looked after by the same team. It is therefore vital for healthcare practitioners (HCP) in primary care to be able to recognise different stages in a patient’s disease trajectory and be able to manage this effectively. Integral to this is a need for exemplary communication with the person and their household, in order that a therapeutic relationship with all is maintained .
We worked with the local Macmillan team to develop four different scenarios involving the same 44-year-old woman with a diagnosis of breast cancer. The scenarios were: neutropenic sepsis during chemotherapy, agitation caused by metastatic disease, conversations around completing a ReSPECT form and preferred place of death, and lastly end of life care and recognition of dying. Before each scenario participants were told how much time had elapsed since the patient had last been ‘seen.’ The simulation suite was set up as a consulting room for the first two scenarios and the patient’s home for the remaining two. We used an experienced Simulated Patient with the patient’s wife being played by one of the faculty.
The session was delivered to an interprofessional group of eight participants and comprised of four different HCP roles. It was jointly facilitated by the author and a member of the Macmillan team.
87.5% of attendees felt that their awareness of oncological emergencies and how they can present in primary care had increased because of the training, with 100% feeling it was relevant to their developmental needs and that it met the learning objectives for the day. There was appreciation of the value of being able to simulate breaking bad news and that the sequential nature of the day made it feel realistic to participants.
Sequential style simulations work well for primary care HCPs who recognise the value of simulation that replicates their own practice. We recommend exploration of further scenarios around end-of-life care and communication.
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2. NICE. Implementation: getting started. Care of dying adults in the last days of life. Guidance. NICE. https://www.nice.org.uk/guidance/ng31/chapter/implementation-getting-started [Accessed on 30/06/2022]
3. UK Government. What’s Important to me. A Review of Choice in End of Life Care. https://www.gov.uk/government/publications/choice-in-end-of-life-care [Accessed on 30/06/2022]