EOL Essentials Project News

Welcome to the September edition of End-of-Life Essentials news. This newsletter aims to keep you informed with what’s happening in the project and end-of-life care. 

• What’s New in the Project?

• Sector News

• Latest Evidence

• For Your Notice Board

• Next Newsletter

What's New in the Project?

There is so much to explore in our on-line modules.

It is not too late to join thousands of Australian doctors, nurses and allied health professionals. In Module 2 you are invited to focus on areas in your communication on which to develop and grow. You will have access to specialised and peer-reviewed video, communication tips and tools, and opportunities to adapt, adopt and develop your communication skills. Watch, learn and then practice how to increase the effectiveness of your communication across a wide range of common end-of-life scenarios.

This module and its resources have been designed for individual use or small group work. It includes quizzes, tips and frameworks, extensive evidence-based resources and interactive learning opportunities.

All modules are free to access. Getting started or returning is easy! Go to our website at www.caresearch.com.au/EndofLifeEssentials and discover more resources and education.

If your hospital IT security is blocking the video play, try these tips:

• You can check with your IT staff, often they have a password to get around the block – there are plenty of fantastic educational resources on YouTube
• Alternatively, you can access all materials on your phone, the End-of-Life Essentials education and resources are designed to be used on mobile devices and tablets
• Alternatively access our resources from your home or public library or free Wi-Fi hotspot.

Sector News

End of Life Law in Australia provides accurate, practical and relevant information to assist you in navigating the challenging legal issues that can arise with end of life decision-making.

This website is an initiative of the Australian Centre for Health Law Research. It is designed to be used by patients, families, health and legal practitioners, the media, policymakers and the broader community to access information about Australian laws relating to death, dying and decision-making at the end of life. These laws are very complex, particularly in Australia where the law differs between States and Territories, and where areas of uncertainty about the law exist. This website provides you with a broad introduction to these laws. It can also help you stay up to date with Recent Developments in the end of life area.

Watch this space. The discussion about End of Life care is gaining momentum in Australia. To further this discussion the Deeble Institute for Health Policy Research brought together researchers, practitioners, policy makers and consumers for a discussion that will lead to the development of a Policy Issues Brief.

This workshop built on the seminar held by the Deeble Institute in Sydney last November. International Perspectives on End of Life Care examined the results of the International Hospitals Federation survey which provided a perspective on end of life care in University hospitals and compared practices across continents. The following discussion centered on how to identify the dying patient, advanced care directives and how we can redevelop hospital practices so that those at end of life receive appropriate treatment. This seminar resulted in a statement on End of Life care that identified principles and markers of success for good care.

The Deeble Institute is now building on this work to answer the question: how should the health system respond to the growing evidence that many Australians want to spend the last part of their lives at home, but can't.

The speakers were:

• Prof Hal Swerissen - Visiting Fellow, Grattan Institute
  View this presentation
• Liz Callaghan - Chief Executive Officer, Palliative Care Australia
• Prof Nicholas Graves - Faculty of Health, QUT
• Prof Ken Hillman - South Western Sydney Clinical School, University of New South Wales
• Dr Ranjana Srivastava - Medical Oncologist and Author, Monash Health Columnist for The Guardian

Latest Evidence

Each month we will feature a few articles that cover topics relevant to end-of-life care in hospitals:

• Hosker CM, Bennett MI. Delirium and agitation at the end of life. BMJ. 2016 Jun 9;353:i3085. doi: 10.1136/bmj.i3085.
  Delirium is common in the last weeks or days of life. It can be distressing for patients and those around them. Successful management involves excluding reversible causes of delirium and balancing drugs that may provoke or maintain delirium while appreciating that most patients want to retain clear cognition at the end of life.
• Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliat Care. 2016 Jul 12;15:59. doi: 10.1186/s12904-016-0133-4.
  This study found that nearly half of all family members wanted more information about possible outcomes of care, including knowledge that the patient was "sick enough to die". Prognostic uncertainty was often poorly communicated, if at all. Inappropriate techniques included information being cloaked in confusing euphemisms, providing unwanted false hope, and incongruence between message and the aggressive level of care being provided. In extreme cases, these techniques left a legacy of uncertainty and suspicion. Family members expressed an awareness of both the challenges and benefits of communicating prognostic uncertainty. Most importantly, respondents who acknowledged that they would have resisted (or did) knowing that the patient was sick enough to die also expressed a retrospective understanding that they would have liked, and benefitted, from more prognostic information that death was a possible or probable outcome of the patient's admission. Family members who reported discussion of prognostic uncertainty also reported high levels of effective communication and satisfaction with care. They also reported long-term benefits of knowing the patient was sick enough to die.
• Hodgkinson S, Ruegger J, Field-Smith A, Latchem S, Ahmedzai SH. Care of dying adults in the last days of life. Clin Med (Lond). 2016 June;16(3):254-8.
  Care of people in their last days of life should be based on compassion, respect and, wherever possible, on research evidence. This Concise Guideline overviews NICE Clinical Guideline (NG31), which addresses: recognising dying; communication and shared decision making; maintaining hydration; and pharmacological symptom control, including anticipatory prescribing. Doctors may need to change their attitudes to care of dying people and those important to them. Specific areas where practices will need to reflect the individualised approach to care are highlighted. Limitations of the guideline are discussed. Potential barriers to implementation include need for further training and 24/7 availability of specialist support to front-line clinicians.

For Your Notice Board

Each month we will feature a fact sheet, a poster or other resource that you can print and share on you notice board or in your tea room.

This month we highlight the figure, Leading causes as a proportion of all male and female deaths, 2014 (74kb pdf) from the Australian Bureau of Statistics Causes of death, Australia, 2014. Canberra: The Bureau; 2016. Report No:3303.0.

Next Newsletter

October 2016

The End-of-Life Essentials News is distributed on the first Wednesday of each month. You are also welcome to forward the newsletter to others who may be interested or follow this link to subscribe to the newsletter. To share something, please email eolessentials@flinders.edu.au