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Dying Matters Week

“Trust is the glue of life. It’s the most essential ingredient in effective communication. It’s the foundational principle that holds all relationships” - Stephen Covey

It’s difficult to overstate the importance of trust. Whether it’s in the world of business, the sphere of public life, or within the four walls of our own homes, trusting relationships are the foundations of life itself. If we don’t trust our clients, our governments, or our partners, things simply don’t work.

But if there’s one sector in which trust is particularly crucial to a functioning system, it’s in palliative care. This branch of medicine is aimed at helping patients with life-limiting or life-threatening illnesses get the most out of life. That could be cancer; it could be a chronic condition such as Parkinson’s, Multiple Sclerosis (MS), Motor Neurone Disease, or COPD.

Whichever element of a patient’s

livelihood is concerned, palliative care – that is practised by hospices, such as ellenor – aims to focus on the quality, rather than the quantity, of their life.

Let’s start with perhaps the most obvious reason – the very baseline of trust required for the patient-doctor relationship to work. After all, if a patient doesn’t have an inherent level of belief not only in their doctors and nurses, but in the wider institution of medicine itself, they won’t agree to receive – let alone seek – professional clinical care.

“I’ve worked in palliative care medicine for over 26 years”, Professor Matt Makin, Medical Director at North Manchester Greater Hospital, says. “And I’ve learnt a lot about how the establishment of trusting relationships can be just as important a part of relieving a patient’s suffering as all the medication and interventions we prescribe.

ellenor cares for some very complicated patients, with very difficult symptoms; it looks after people experiencing great psychological, emotional, and spiritual distress. But because of the trusting relationship that the staff develop with patients – and vice versa – they’re more likely to feel safe, well-cared-for, and secure. As a consequence, this element of trust can have a massively positive impact on their experience of suffering”.

But how is trust built at an organisation like ellenor?

For some, such as May Shurmer, Senior Staff Nurse, it’s through transparency – by engaging in open communication with patients and families, even if that means confronting difficult truths. Cultivating trust involves refusing to shy away from the uncomfortable; it means embracing the conversations that, though hard, bring understanding and closure.

“We always say to families ‘if you ask us a question, we will tell you the truth”, May says. “It’s not our right to take away from those families that time that they have left. We’re never ‘ready’ for death but having those honest conversations can help patients and their loved ones prepare for it and allow it to be peaceful”.

Communication, then, is a key ingredient in the recipe for engendering trust between patients and the healthcare professionals at their local hospice. But there’s another aspect of hospice care in which trust is equally vital – the kind that exists between the doctors, nurses, and various external organisations they partner with for success.

ellenor, for instance, has been working with Professor Makin’s palliative care consultancy, Supportive Care UK, for two years. With access to integrated on-the-job training, advice, and a comprehensive system of governance from a team of experts, the doctors on ellenor’s IPW (inpatient Ward) have benefited from the checks and challenges this support has provided.

Yet again, there’s one crucial element required for this alliance to succeed.

“Trust”, Professor Makin agrees, “has been a vital component of Supportive Care UK’s partnership with ellenor. You can’t always assume that doctors are going to accept the consultancy model – that someone is going to call you and discuss your management plans and ask you some difficult questions’”.

“There are a lot of doctors who’d have said ‘no thank you, we’re okay – we don’t want anyone looking over our shoulder’. I think it’s a credit to ellenor’s doctors – the likes of Dr Sheraz Majeed, and Dr Naseem Tariq – who’ve welcomed those checks and challenges and understood that we’re here to provide assurance. That’s good for patients, it’s good for us, and it’s good for the hospice”.

To return to Stephen Covey’s famous quote, trust is “the glue of life”. In a hospice setting, this choice of language feels apt – particularly because, for ellenor’s patients and families living through the most challenging of circumstances, life can feel as though it’s falling apart.

Similarly, trust as adhesive is a suitable metaphor to relate how the interconnected parts of the healthcare system are fused together; to describe that force which bonds ellenor’s team to its patients and motivates them to provide the utmost levels of tailored, personal, holistic care.

Without trust, things come unstuck. With it come the building blocks of empathy, communication, even love – of care that arises not only out of duty or responsibility, but from a genuine respect for the patient and one another. With it comes better decision-making and collaborations, closure and peace of mind.

With trust – and with effective communication – arises a hospice model accessible to more people, with more influence and involvement within the local community.