‘How can I improve my chances of a good death?’ New Our Future Health podcast

Via podcasts, debates, surveys and events, this yearlong campaign aims to explore the challenges facing doctors and patients in 2018.  

To begin this campaign, today the RCP has launched the first of what will be a series of Our Future Health podcasts, with this edition focusing on the topic of end-of-life-care.     

In what is a wide ranging podcast, three panel members, including a patient with advanced breast cancer, discuss with RCP president Jane Dacre the complexities of end-of-life-care from both the patient and doctor perspective. 

 The panel for this podcast was: 

• Professor Bee Wee, national clinical director for end of life care for NHS England and consultant in palliative medicine at Oxford University Hospitals NHS Foundation Trust 
• Dr Amy Proffit, consultant in palliative medicine at Barts Health and honorary secretary to the association for palliative medicine of Great Britain and Ireland,
• Claire Myerson, patient with metastatic, advanced breast cancer and patient advocate member of Breast Cancer Care’s Change Makers group.

Discussing the questions, ‘are we over treating?’, ‘do we as physicians see death as a failure?’ and ‘what is advanced care planning and what does this mean for the patient?’, the podcast  includes in-depth discussion, and challenges some of the medical profession’s current thinking on end- of- life-care and what can be done to change things. 

Excerpts from the discussion:

Dr Amy Proffit:

I think as physicians, going through medical school, we are very much trained to cure. We are trained to deal with things that we can change. And often the realisation that there are things we can’t change, can feel like a failure of our treatment of that individual person… We do have a tendency to keep going. Just because we can doesn’t always mean we should. We need to be putting patients back at the centre of those kinds of decisions. 

Claire Myerson:

When I think about advanced care planning, it is about answering the question, how can I improve my chances of a good death? My life is limited, mostly likely from cancer and the only thing that is difficult is when that is going to be. For me this is 10% clinical and 90% emotional and practical.

I can’t control the disease progression… but one thing I might be able to do is to manage the practical and emotional side of it – to understand and make plans. What is the disease progression actually going to look like? What the treatments are? And if they are going to give me an improved quality of life and what the side effects are likely to be so I can make a judgement on the impact on my quality of life and those around me.     

Professor Bee Wee:

I think it is our shift in attitude that is really important. If we begin to value honest conversations, if we place equal value on that, to the conversation about offering the next intervention, or the next cycle of treatment, then it might help clinicians offer something as valuable as a specific intervention.

You can listen to the full podcast on the Our Future Health website .     

Commenting on the launch of the project, RCP president Professor Jane Dacre said: 

Our Future Health will really allow us to start to explore the complex dilemmas we as physicians face in the NHS in 2018. By looking at a broad range of factors from investment and resources, to research and innovation we will start to at least air these complex questions and help us find solutions for future physicians.  

On the wider project, RCP clinical fellow Dr Sarah-Jane Bailey said: 

This is a worthwhile programme of events that will be discussing really important issues facing the NHS today. Addressing how these factors affect doctors and patients day-to-day on the ground. 

The aim is to include all grades of doctors from right across the UK, in order to get a strong sense from them as to how we can address the current challenges in the short, medium and long term.