Improving the assessment of cultural, religious and spiritual needs for patients at the end-of-life within an acute hospital trust.

Background: Cultural, religious and spiritual (CRS) needs become increasingly important to individuals as they approach the end of life. CRS needs often remain unmet for patients dying in an acute hospital setting. The 'Just Ask' quality improvement project was designed to explore barriers to routine assessment of CRS needs, and to design resources and intervention to support staff to increase assessment of these needs.

Aims: The primary aim of the project was to increase the number of patients receiving end-of-life care in hospital with a documented CRS needs assessment from 43% (based on audit data) to greater than 50% over the 9-month project.

Design: The study occurred in two phases.The scoping phase evaluated the current service, enablers, barriers and confidence in assessing CRS needs using an online staff survey and four staff focus groups. Results were analysed using qualitative content analysis, descriptive statistics and thematic analysis and informed the intervention phase.The intervention phase consisted of two Plan-Do-Study-Act (PDSA) cycles focusing on resource visibility/accessibility, organisational value placed on CRS needs assessment and staff education.Outcomes (documented CRS needs assessment) were measured by case notes review over 3 month periods - 1 year prior to and after the PDSA cycles. The impact of education interventions on staff confidence relating to CRS needs assessment were measured via an anonymous questionnaire.

Outcome: Documented assessment of CRS needs increased from 43% to 57% in patients receiving end-of-life care in our hospital. Staff confidence scores in CRS needs assessment increased by 46-87%.

Conclusions: The factors that influence the addressing of CRS needs in a busy hospital are multifactorial. Organisational culture, appropriate resource provision and visibility, and education are essential factors in supporting staff to recognise, understand and engage with CRS needs assessment in patients receiving end-of-life care in hospital.