Hospitals and end of life care – reactions to a paper

Labouring in the fields of academia can so often result in a product that is consumed only by a few like minded folk. So it can be quite a surprise when our efforts resonate widely with a larger community of interest.  On 17 March we published our paper on Imminence of death in hospital patients  The media reaction was extraordinary – inspiring to the authors, rewarding for the the Palliative Medicine journal editorial team,  and testimony to the reach that can be achieved when a University and publisher work together to generate interest in a publication.

Preparing for launch

The University of Glasgow communications team and the journal had produced a plan to publicise the paper. I had prepared a blog post and my Twitter thumb was at the ready on publication day. The reported study had been complex to undertake but had a simple message: almost 29% of those in hospital in Scotland at any one time can be expected to die within 12 months; and 9% will die on that admission. Would it gain a reaction? Or would  it be completely overlooked as the nation’s  gaze turned to George Osborne and his budget day speech?

I had sensed for a long time that this paper was important.  First, such a study had never been done before and whilst clinicians might have a good sense of the numbers in question, no one had yet produced solid evidence on propensity to die among hospital patients. Second, the paper seemed to me to give support to all those advocating for better engagement with end of life care in hospital settings – such as the Hospice Friendly Hospitals in Ireland, those working on the aftermath of the Liverpool Care Pathway, as well as the many patients and families who have expressed concern about these issues in recent times.  The resulting media attention absolutely confirmed that sense, albeit in ways far beyond expectation.

Metrics

Here are the headlines. In the days following publication reports about the paper appeared in:

• 8 national newspapers
• Over 40 radio clips on the BBC UK network
• Over 15 local TV clips on the BBC UK network
• UK television (BBC breakfast and News 24)
• UK Radio  (Radio 4 Today Programme, BBC Radio 2 and BBC Five Live)
• Scottish Radio (5 radio clips)
• Scottish Television (BBC Reporting Scotland, Scotland Tonight, STV News)
• BBC online

The editor of Palliative Medicine, Catherine Walshe, also introduced me to a new source of information on ‘reach’: Altmetrics.  This facility, which I had not come across before,  generates a measure of the ‘buzz’ around a paper when it first appears – and well before citations start to occur.  Ten days after our paper appeared in the journal’s  Online First format it had generated an Altmetrics score of 101. I learned that the average score for the journal is nine and that this placed it third in the Altmetrics rankings of 447 Palliative Medicine papers . It had been mentioned by no less than 89 Tweeters.

Traffic to this blog on publication day and subsequently was also at record levels. On 18 March there were 168 views on the blog and 104 of these were for the item on the new paper itself. Interest remained strong in the following days and got a further boost when a letter about the study appeared in The Times on 21 March.

Reactions and next steps

In general the mass media had a good sense of the purpose of the paper. Several broadcasters highlighted that it is not a comment on the quality of care, but rather an opportunity for hospitals to think more actively about how they engage with that significant portion of their patients who at any one time are in the last year of life.  The Herald in particular gave a detailed summary as well as comments from Age Scotland and Scottish Government. Radio Four’s Sarah Montague was eager to know where the results would  be replicated elsewhere. BBC Scotland’s Eleanor Bradford presented a well reasoned piece that also highlighted approaches to early identification of patients with palliative care needs, on admission to hospital – a theme that was picked up a few days later in a ‘magazine style’ piece on the BBC Reporting Scotland radio programme.

In the social media there was huge interest from professionals working in palliative care and in hospitals in general. The sense of excitement and support from colleagues was genuinely rewarding. Some were quick to ask questions – could individual hospital data be released, how did length of stay compare between those who died and those who did not, were there any special features of the 31 March 2010 (our census date) that might have influenced the outcome, does Scottish end of life provision differ from other parts of the UK? Others talked more about what we now do to identify  and respond. Some emphasised the role of primary care and district nursing services in avoiding admission to hospital.  To pursue some of these themes,  a Twitter journal club  @hpmJC has been organised for 11am on Friday 4 April, when I look forward to further discussion.

Overall the reaction to the paper has been fascinating to observe.  I am grateful to everyone who has shown interest and now look forward to responses that arise as the paper becomes better known and its implications are more widely explored.  Famous for fifteen minutes? We shall see how our paper fares!

David Clark