Project type: Quality improvement    

Contact and country: lubaina.bahar@nhs.net (United Kingdom)        

Summary: The Difficult Conversations Workshop is a one-day interactive educational event designed for healthcare professionals to develop the confidence, communication skills, and emotional resilience needed to navigate challenging conversations in clinical practice. Through a combination of expert-led lectures, case-based discussions, group exercises, and panel sessions, participants explore topics including breaking bad news, DNACPR and treatment escalation planning, end-of-life care, duty of candour, communicating when English is not a first language, dealing with aggressive relatives, fostering psychological safety within teams, and managing difficult interactions with colleagues. The workshop concludes with facilitated group discussions that allow delegates to apply practical communication frameworks to real-world scenarios and leave with a concise Difficult Conversations Toolkit to support their everyday practice.  Three of these workshops have already been successfully organized.

Linked resources/publications: Abstract has been submitted to the upcoming conference of Academy of Medical Educators. Awaiting acceptance. An e-poster has been presented and won the first prize in the recently organised Palliative Care in Critical Care Conference 2026 conference in Winchester.

Project type: Quality improvement    

Contact and country: : achvini.sriskanthanathan@nhs.net and apimaan.yogeswaran@nhs.net (England)      

Summary: Documentation audit to assess end of life care planning in ICU and recognition of the dying patient

Linked resources/publications: TBC

Project type: Quality improvement    

Contact and country: achvini.sriskanthanathan@nhs.net and apimaan.yogeswaran@nhs.net (England)    

Summary: A one-day workshop was designed and delivered based on a local needs assessment. Topics included treatment escalation planning and DNACPR discussions, communication when English is not a first language, duty of candour, managing distressed or aggressive relatives, end-of-life conversations, psychological safety within teams, and navigating challenging colleague interactions.

Linked resources/publications: TBC

Project type: Quality improvement    

Contact and country: Melanie.Pinnington@merseywestlancs.nhs.uk (UK)       

Summary: We introduced a moment of silence and reflection in Southport critical care unit, which we call The Pause during Covid This was to initially help with the prevention of moral injury to health care staff when a death is unexpected or the staff have worked to improve outcomes but it was futile. We could find no other evidence at the time of this happening in Critical care units. What we have also realised is the massive impact this has on families who also need to process their grief. this practice is now fully embedded into our end-of-life care and is warmly received by staff and families. We won the Nursing Times Award for emergency and Critical Care Award with this initiative in 2023 , have presented at several conferences and have been published. This is an easy to embed but hugely impactful change for all concerned in end-of-Life care and we would love to support embedding it in other areas.

Linked resources/publications: TBC

Project type: Audit    

Contact and country: meng.naleong@nhs.net (UK)     

Summary: An audit was conducted to review end-of-life (EoL) care for adult patients who died and were recognized as EoL in the intensive care unit (ICU) at Charing Cross Hospital, London. The audit aimed to identify practice gaps against NICE guidelines: Care of dying adults in the last days of life. Data recognized as quality indicators of good EoL care were collected, namely, ICU-specific EoL care plans, symptom management, EoL communication, bereavement, and chaplaincy support.

Linked resources/publications: TBC

Project type: Research   

Contact and country: d.hamal@nhs.net (UK)   

Summary: We retrospectively analysed NACEL KCH DH data from 2018-2026 comparing local performance (Kings College Hospital, Denmark Hill) to national and London benchmarks. A supplementary NACEL-style case note review was undertaken for 28 CCU deaths in 2025 scrutinising  two key NACEL indicators – Communication and documentation regarding hydration and nutrition, individualised personalised care (IPC) planning. Alongside this, we collated key confounders including palliative care reviews, withdrawal/withholding of life-sustaining treatment (WLST) practices.

Linked resources/publications: Submitted to APMJ Kaleidoscope in Care conference

Project type: Service development     

Contact and country: ggc.criticalcare.psychologyservice@nhs.scot (Scotland)   

Summary: Development of psychology service which includes family support. We do not offer bereavement support, however, offer support during end-of-life care (including anticipatory grief) whilst in ICU and provide guidance and signposting to access relevant services for ongoing psychological support if required. This includes meeting directly with patients, families and consultation with staff. We are a two-year endowment funded service, therefore are continually collating feedback from families regarding the impact of offer of support.

Linked resources/publications: TBC

Project type: Quality improvement    

Contact and country: sameera.jahagirdar@nhs.net (UK)       

Summary: A two-phase PDSA QI project at a London ICU (West Middlesex University Hospital) examining Compassionate Care Agreement (CCA) documentation for patients in the last hours and days of life. Phase 1 found that while the large majority of staff understood the importance of CCA documentation, actual completion occurred in only ~6.5% of 92 ICU deaths ‚ pointing to a communication-confidence gap rather than a knowledge gap. This was followed by a multidisciplinary educational intervention (simulation sessions and flipped classroom teaching), reaching 65 staff between April and October 2025. Phase 2 data collection will start in October 2026 to assess the impact of the intervention on documentation compliance.

Linked resources/publications: A poster abstract on Phase 1 findings was presented at the Intensive Care Society State of the Art Conference, Birmingham (2025), and published in the ICS journal. A separate poster abstract has also been submitted to PCiCC (Palliative Care in Critical Care) 2026, alongside an abstract on the EOLC education/simulation programme delivered as part of the project. Happy to share any of these or discuss further.

Project type: Quality improvement    

Contact and country: sameera.jahagirdar@nhs.net (UK)

Summary: Developed through the CW Innovation Horizon Fellowship, this project is building an AI-powered platform to support empathetic family communication and documentation during end-of-life care transitions in critical care. It’s grounded in findings from a local ICU audit that identified a substantial gap between staff understanding of EOLC documentation and actual completion in practice. The project is currently at grant application stage (THRIVE, UKRI Proof of Concept), with an NIHR application in development.

Linked resources/publications: Project details are available via the Digital Health London webpage: https://digitalhealth.london/embedding-digital-empathy-to-transform-end-of-life-care-transitions.

Project type: Research    

Contact and country: Martin.Neukirchen@med.uni-duesseldorf.de (Germany, Israel, Tschech Republic, Italy, Greece)     

Summary: Randomized controlled multi-center trial, primary outcome. Length of ICU stay: https://epic4icu.eu/

Linked resources/publications: Mentzelopoulos SD, Hartog CS, Tenge T, Schwenkglenks M, Piper SK, Barbier M, Rusinova K, Neukirchen M, Schüürhuis S, Jensen HI, van Heerden V, Dutzmann J, Drescher D, Zvara M, Metaxa V, Nachshon A, De Robertis E, Spies C, Edel A. Enhancing palliative care in intensive care units: protocol of EPIC, a controlled, cluster-randomised, non-blinded stepped-wedge design trial with crossover phase. BMJ Open. 2026 Feb 17;16(2):e108168. doi: 10.1136/bmjopen-2025-108168. PMID: 41702660; PMCID: PMC12918684.