There was a recognition that the demand for specialist palliative care services was likely to increase, reinforcing the need to enhance the capacity for providing palliative care within the

stroke service. Despite the increase in the numbers of patients with palliative care needs accessing stroke services, no evidence of a systematic approach to staff development was identified, with staff “learning on the job” [3:32]. Whilst a lack of staff development Inhibitors,research,lifescience,medical and training was identified, participants highlighted a number of opportunities that were felt to enhance the provision of palliative care. Case management, including the nomination of a key individual to liaise with family members, and to coordinate palliative care provision

for individual patients was highlighted as having potential. “… maybe a key person to be involved with the family and the patient. And if they’re happy with that key person, then they’ve got somebody familiar and they can feel they can trust them and give them Inhibitors,research,lifescience,medical the true, realistic, how the situation is, so that they can get the right input in. [1:12]” The ability of the clinical environments to support the delivery of palliative care precipitated a considerable amount of staff discussion. The appropriateness of single rooms for those patients dying was equivocal, as Inhibitors,research,lifescience,medical “isolating somebody in a cubicle in their last hours of life is very, very lonely” [2:29]. Some participants felt uncomfortable about providing rehabilitation Inhibitors,research,lifescience,medical interventions, particularly when these required verbal encouragement, in close proximity to patients who were at the end of life. “I do feel not particularly at ease if I know there’s somebody who is acutely unwell and I’m “come on Mrs Miggins, let’s stand up” you know. [3:34]” In addition, the general business Inhibitors,research,lifescience,medical of the stroke service settings appeared

to mitigate against a peaceful, restful and more appropriate environment for those with palliative care needs. “I still think that there are environmental issues with an acute ward that, with the best will in the world, we have admissions coming in, happy wanderers, HKI-272 purchase unhappy wanderers, muddled people, irritated people, in a relatively small space and a lot, you know we’ve got OTs, physios, speech and language, dieticians, pharmacists, medics, nurses, domestics, next that’s a very busy environment and it isn’t conducive to rest. [3:44]” Working with families Honesty was valued by patients and families, even where prognosis was uncertain. However, staff were concerned about raising hope, and potentially false optimism. “I think for relatives of these patients, nobody actually discusses the expectations and when you say we’re going to move them to the Stroke Unit, that can give false hope.