Dying Matters Week: Staff profile – Nicole Satullo

Meet Nicole. She's a Palliative Care Equality, Diversity, and Inclusion (EDI) Officer for Palliative Medicine at Oxford University Hospitals NHS Foundation Trust (OUH), and also works with our Sobell House Hospice and Katharine House Hospice colleagues.

With her role funded by Sobell House Hospice Charity, she started working with us in January 2022 and has made a significant impact in terms of applying EDI principles to end of life care and tackling health inequalities.

Palliative care and ethnicity data

Nicole has worked with frontline teams to address the challenge of acquiring full ethnicity and religion data from palliative care patients, which has allowed the Palliative Care team to identify areas where needs aren't fully met, and to also further tailor their care for individual patients and their families.

She said: "Our palliative medicine department provides holistic care around death and dying both in our hospitals and hospices and in the community. That care must include patients' cultural and spiritual needs. Collecting this information sensitively and accurately, so it can be shared with the whole team, is really important. It also helps us to understand who is and is not accessing our care in the community, so that we can develop new outreach strategies to make sure our specialist care reaches those who need it most."

Palliative care and homelessness

Unfortunately, one such group that does not often receive palliative care are people experiencing homelessness, despite being more likely to die prematurely.

To capture the perspectives of people on the homeless pathway, Nicole held focus groups in partnership with LEAF (the Lived Experience Advisory Forum) at the Gatehouse to understand what matters most when they, or someone close to them, is dying. Armed with these results, she initiated a homelessness outreach project, funded by St James' Place Charitable Foundation and Sobell House Hospice Charity.

Nicole said: "At the end of someone's life, we have one chance to get it right – everyone that needs palliative care should be able to access it regardless of who they are, where they live, or the circumstances of their life.

"People who are homeless or vulnerable can have very complex lives, with competing priorities of meeting basic needs including housing and food, as well as possibly managing addiction and mental health issues. That often means their physical health is overlooked, and engaging with healthcare professionals can be challenging.

"All too often, there are barriers that prevent people from accessing that care. It's incredibly important that we do all that we can to remove them. The earlier someone engages with health services, even if they are near the end of their life, the more we can support them to live out their remaining time in the way they wish – with dignity and support, in the best living situation for their needs, just like we would for any of our patients."

Conversations with our staff about palliative care

Nicole and her colleagues are also working with OUH and hospice staff to enhance their skills in supporting patients from all walks of life.

This includes training about trauma-informed care, neurodiversity, dementia, the impacts of poverty at end of life, and various religious practices as well as broader conversations around death and palliative care.

In November, the OUH Palliative Medicine department held EDI Fairs with occupational and physical therapists. Staff were invited to experience different conditions patients might live with and think about how they could be supported to maintain independence and keep living well within hospices and in the community.

Nicole said: "This helps show that EDI is for everyone - we may all have physical disabilities, mental health, spiritual, or other needs at different points in our lives. EDI impacts and benefits us all."

Nicole is also leading efforts to bring patient and public involvement to improve the service. Patients, current and former carers, and members of the public are involved in improving the readability of patient information leaflets and letters following an outpatient appointment, and the way food menus are presented on the ward.

She said: "These little things can make a huge difference to patients and families navigating a challenging time. Ultimately, any improvements we make to patient care around these subjects go beyond palliative care.  This work to reduce health inequalities and make sure our care is patient and community-centred goes directly towards the Trust's strategy around health inequalities and serving our population.

Everyone deserves kindness, dignity, and compassion at the end of their life. By continuing to work towards reaching more people who may not have otherwise engaged with healthcare services, we are coming closer to providing the best possible care for marginalised communities, and everyone, at a time when they need it the most."