Adding a post-bereavement survey to the National Care of the
Dying Audit - Hospitals could be a valuable way to help improve
care, according to a research paper in the BMJ Supportive and
The 'Care Of the Dying Evaluation' (CODE) questionnaire was
first developed in 2011 by Dr Catriona Mayland, Honorary Senior
Clinical Lecturer at the Marie Curie Palliative Care Institute
Liverpool, University of Liverpool and Consultant in Palliative
Medicine at the Royal Liverpool and Broadgreen University Hospitals
The questionnaire was added as an additional component to the
2013/2014 National Care of the Dying Audit - Hospitals (NCDAH), led
by the Royal College of Physicians and Marie Curie Palliative Care
Institute Liverpool, to evaluate the quality of care provided to
dying patients and their families in acute hospitals, from the
perspective of bereaved relatives.
The NCDAH found significant variations in care across hospitals
in England and that major improvements need to be made to ensure
better care for dying people, and better support for their
families, carers, friends and those important to them.
858 bereaved relatives returned a completed CODE
On the whole, the majority of participants reported good or
excellent care, with patients' symptoms generally perceived to be
well controlled and 769 (91%) of participants reporting that either
no pain was present or only there 'some of the time.
However, a small but significant minority perceived poor quality
of patient care.
Clear and timely communication was identified as an urgent issue
to be addressed, with unmet information needs being a recognised
area for improvement, for example, 230 (29%) reporting that having
a discussion about hydration would have been beneficial.
The BMJ Supportive and Palliative Care paper concludes that
adopting a post-bereavement survey appears to be a feasible,
acceptable and valuable addition to the national audit.
Dr Catriona Mayland said, "CODE helps us understand the real
experiences of bereaved relatives and their loved ones and identify
areas that would improve the experience of care for the dying. This
is a significant and helpful addition to an audit of patient
documentation for care for the dying, which if continued can make a
real contribution to improving quality of care."
Dr Stephen Mason and Dr Catriona Mayland from the Marie Curie
Palliative Care Institute, University of Liverpool have also
recently been awarded a Wellcome Trust Public Engagement Grant to
support public engagement events to further develop CODE.
The paper can be accessed online at: http://spcare.bmj.com/cgi/content/abstract/bmjspcare-2014-000810