
Module 1: Introduction
1.1 Welcome
Learning outcomes
By the end of this course you will be able to:
- outline key principles of end-of-life care and recognise why it can be important to discuss palliative options alongside decisions about life-sustaining treatment
- identify clinical issues in the care of patients with Prolonged Disorders of Consciousness following the discontinuation of Clinically Assisted Nutrition and Hydration [CANH]
- recognise the need to develop an appropriate palliative care plan and know where to find relevant clinical guidelines
- reflect on specific ethical, clinical, and social concerns in relation to Clinically Assisted Nutrition and Hydration [CANH]
- identify some of the issues that might impact on you, or other team members, and reflect on ways of supporting each other
- summarise common ideas about how a patient might die if CANH is discontinued and identify key information and support needs (for yourself, your colleagues and for families)
- outline research findings into family experiences of witnessing the dying process following such treatment being discontinued
- provide relevant information to families and signpost key resources for family and friends
The End-of-Life care course will take around 3 hours depending on your existing knowledge base and level of engagement with each module. The course is designed so you can study in half hour chunks of time, or however suits you.
Optional additional CPD: The course includes optional CPD portfolio exercises if you want to extend and deepen your learning and produce action plans for your organisation.
Click on the audio below to listen to an introduction (2 minutes) from Professor Jenny Kitzinger. Text version of the audio is available here

Jenny Kitzinger
Click here for Text Version of welcome audio
What is the course about? Welcome to this short course on end-of-life care for patients in ‘Prolonged Disorders of Consciousness’. The focus in on patients in vegetative or minimally conscious states. The course explores staff and family views, experiences and support needs when considering discontinuation of clinically-assisted nutrition and hydration and provides an introduction to related palliative care issues.
Who is it for? This course is designed primarily for staff working in hospices, rehabilitation centres and care homes and can be useful whatever your level of experience.
When is this training useful? We developed this training in response to staff asking for support around decision-making or after decisions had been made about withdrawing feeding tubes from patients. The training is designed to be done at any point and it is important in fact not to wait until after such decisions have been made. Knowledge about different end-of-life care pathways are important to inform decision-making itself. In addition, providing information and support well in advance can be very helpful to the whole multi-disciplinary team and to the families involved.
Course structure: The course has different units most of which take about 10 or 20 minutes to complete. There are short film clips and presentations to watch and reflective exercises and quizzes too.
Kit: You can do the course on any computer or mobile phone that connects to the internet. You’ll need to use your in-built speaker or earphones for listening to the film clips. There are simplified transcriptions of the interviews with health care staff and family members – but you’ll get a much more powerful sense of what people are saying if you can hear them speak for themselves.
Continuing Professional Development certificate: At the end of the course you’ll have an opportunity to summarise your learning and give feedback and to download your Continuing Professional Development [CPD] certificate.
Images used in this course: We wanted to avoid stock images of crinkly hands, intensive care machines or ‘sleeping beauties’ that so often illustrate end-of-life care. We were delighted to have the opportunity to collaborate with Tim Sanders (visual artist and cartoonist) and Karin Andrews Jashapara (shadow puppet theatre producer). We hope you’ll enjoy seeing some of their work. The photographs below show Karin Andrews Jashapara at work creating ‘shadow puppet theatre’ exploring some of the themes unpacked in this course.



Optional CPD portfolio exercises: optional CPD exercises are clearly indicated in some learning units. It is entirely up to you (and perhaps your line manager?) whether or not you want to do the extra, advanced, learning. Don’t get distracted by these exercises if you just want to refresh your knowledge or get the core course under your belt!
The optional CPD exercises offer the opportunity to:
- develop a draft palliative care plan in line with PDoC guidelines about clinical management (Unit 2.3)
- map out a strategy to enhance staff support in your organisation around end-of-life care (Unit 3.4)
- review a research article about family concerns and devise a plan to enhance family support (Unit 4.1)
- focus on legal and best interests issues around the timing of treatment withdrawal (Unit 4.8)
- engage in depth with legal and philosophical debates about ethics, human rights and dignity (Unit 4.9)
Hint for learners: save a printed .pdf copy of course materials: Some learners like to print out or save a .pdf copy of the core materials. They use this for their CPD portfolio and to help them keep notes. It also gives them something they can refer to after finishing the course. On most systems you can save a .pdf by opening the relevant learning unit, then selecting ‘print’ from your top toolbar on your computer, and opting for ‘save as .pdf’. Remember, if you want to include transcripts from the videos, then press ‘show text’ option beneath the videos.
Who produced the course?
The course development was led by Professor Jenny Kitzinger (Cardiff University) with support from other members of Cardiff University: Professor Celia Kitzinger (School of Law), Dr Julie Latchem-Hastings (Health Sciences) and Dr Geraldine Latchem-Hastings (Health Sciences). Between us, we bring together expertise in family experience, communication, law, ethics and clinical practice.
Who contributed?
We’re very grateful for the skill of our website developer and educational technologist partner, Liz Fahy (Geckosurfing). We also had lots of input from different healthcare professionals (working across palliative care, medical ethics and neuro-rehabilitation) and are grateful to everyone working in the field who contributed their insights and agreed to be interviewed for the resource. The course is also underpinned by the insights and experiences of families with relatives in prolonged disorders of consciousness. It’s been great team work! While working through the materials you’ll see clips from interviews with some of the huge range of people who helped with course development.
Marie Curie 'Research to Impact' Funding
We’re also grateful to Marie Curie Research Impact funding for helping us further develop this initiative, and our colleagues on that project for all their expert input.
Learners supported by the Marie Curie ‘Research to Impact’ fund
For all learners studying under the initiative supported by Marie Curie, please register with on our Sign Up Form. This link will take you to Mail Chimp and after completing a short form you can return to this unit.
We hope you find this course valuable and that it helps to improve care for patients, staff and patients’ families.
Now click on the ‘Mark as Completed’ button at the bottom of this page.
Then click on the ‘Next Unit’ button to move on through the course.
10 Comments
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I am really looking forward to engaging with this course. Many thanks
Hi – welcome to the team from Llandough Hospital – nice to see you doing this as a team….introductions from others are at the end of the next unit!
Hello, I am from the Neurorehabilitation Unit in Llandough Hospital, Cardiff. Looking forward to working through this. 🙂
Hello all, I am a Speech and Language Therapist, also from the neuro rehabilitation unit in Llandough hospital. Looking forward to completing this course with everyone – thanks Gina
Hi all, I’m a Dietitian also from the neurorehab unit in Llandough. Looking forward to learning!
Hello, thanks for the opportunity to take this training course. I’m a Clinical Psychologist working in the PDOC specialist service in UHL, Cardiff.
Hello, I am Steph a Speech & Language Therapist working at the Neuro Rehab Unit in Llandough. Looking forward to working through the course, I’ve found the layout/ structure great already, thanks 🙂
Hello, I am a consultant anaesthesiologist in a government hospital in India and have been practicing palliative care medicine since 2016. Looking forward to working through the course.
hello, I am sreedhu from chadwick ward
Hello, I am an Occupational Therapist working at the Neuro Rehab Unit in Llandough. Looking forward to working through this course. I have learnt a lot from previous CDOC courses I have completed. Thank you!