In search of a good death

Editor—Death is still society's final taboo, as the article by Ellershaw and Ward showed.¹ All medical schools in the United Kingdom now include some teaching on palliative care in their undergraduate curriculum, but most of the emphasis has been on the care of patients dying of advanced cancer. Much palliative care teaching continues to be didactic and formal assessment is rare.²

Despite almost all students being taught palliative care within undergraduate training, house officers struggle more with this aspect of work than almost any other during their first years on the wards and are frustrated by their lack of skills and knowledge when caring for a patient who is dying. Many patients and families find the provision of palliative care delivered in an effective yet caring manner falls far short of their expectations.³

Nurses at all levels also have a crucial role in providing and delivering palliative care. They spend their immediate postregistration period in hospitals where they will encounter many patients with palliative care needs. A recent paper showed that undergraduate nursing students receive a mean of 12.2 hours of teaching in palliative care, compared with a mean of 20 hours' teaching offered to undergraduate medical students in the United Kingdom.⁴ The teaching delivered to undergraduate nurses was mainly theoretical and rarely formally assessed. Tutors identified the lack of suitably skilled staff to teach palliative care and the shortage of placements for nursing students within a palliative care setting as particular difficulties.

The key to providing effective palliative care for all has to be the provision of a generic evaluated and assessed core undergraduate curriculum for medical and nursing undergraduates coupled with appropriate postgraduate and continuing professional education, but it is also important to remember that the way this care is delivered has longlasting effects on patients and their families.